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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N°(:52=4 Date: :J Owner:�e!t-rl.+t" Builder — Address Address / O UILDING No. L Street —Part of Lot Lot _ Block Addition or Sub-Divisio Corner Lot __ Inside Lot Setback Sideyard Sewer Elevation _ Foundation Elevation DESCRIPTION OF BUILDING To Used Front Depth N Height " Sq. Fit r Cu. Ft. A_r-JA Depth Height Sq. Ft. Cu. Ft. Type of Construction-� Est.^Cast 1 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 prdinances 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 anyupon violations any of the provisions of said ordinances. a A,4 ) rsi " NOTICE: This permit does not cover the construction, Installation for wiring, plumbing, gas heating, sewer or water. Be sun to ase the Building Inspector for separate permits for these items. • 4 • a APPLICATION FOR BUILDING PMUUT CITY OF FRIDLEY, MINNESOTA , Owner's Name Builders �� Address Address/� LOCATION OF BUILDING No. 6 �-/l Street S` ���� Part of Lot LotBlock �� Addition or Subdivision,/ Corner Lot Inside Lot Setback ��� Side -Yard e"® SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. To be used as: DESCRIPTION OF BUILDING l Depth Sq. Ft.. rZ�C) Cu. Ft. / Front Depth Height Sq. Ft. Gu. Ft. Type of Constructions 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 representations stated in this application are true and cnrrAet_ DAA_- (A Schedule of Fee Costs can be found on the Reverse Side.) 0 , . MINDEREiNGINEFIZING CO.JNCO ENGINEERS AND SURVEYORS LAND 9UQVE,eIN6 SOILS TESTING CIVIL d MUNICIPAL ENGINEERING LANA PLANNING 6418-SGTN AVENUE N. MINNEAPOLIS 2T, MINN. KE 7- 3637 C*p-tUfiltd%lie *IF G lanewfi ry SURVEY FOP, Toni 5ILV Y— I it, I w1 �1 rn -�01 I II T � 1 r. l� . a l f r F r WE HEREBY CERTIFY THAT T1115 IS A TRUE ANO CORRECT REPRESENTATION OF A SURVEY OF THE BOUNOPAIES OF THE LAND ABOVE DESCRIBED AND OF THE LOCATION OF ALL BUILDINGS, IF ANY, THEREON , AND ALL VISIBLE ENCROACHMENTS, IF ANY, FROM OR ON SAID LAND. MINDER ENGINEERING CO.,'INC. rd Ov: DATED THIS OAYOF �D1�5y ENGIN, E.RS AND 's a- ORS by - a, �) 1 Application for Power Plants and Heating, Cooling, Ventilation, .Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL, Furnace Shell & Duct Work .......................... 8.00 Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ NECK. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ . r each add. 80,000 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 $ GAS FITTING FEES: NO RATE TEAL 1st 3 Fixtures x $1.50 $� Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH See Fee Schedule $ TOTAL FEE Dept. of Bldgs. Phone SU. 4-7470 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, Mjnn.�� ► ,: —� 19 L Owner N C:)M 1 k Q 1– L .n D'". L, Kind of Building Used as !�R C l To be completed about Estimated Cost, $ Old—NeW,t3iulding Permit No. 7 Permit No. DESCRIPTION OF WORK HEATING or POWER(( PLANTS—Steam, Hot Water, QUI ir-No� Trade Name Size No�c� �� �l Capacity Sq. Ft. E.D.R BTUAO-0-16W H.P. Total Connected Load 95 Kind of Fuel - BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS—OVER) Signe S6 CGS By .10P 42 sM r_s9 Business Phone No City of Fridley J Application for Plumbing and Gas Fitting Permit Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORE// - Number, Rind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE BATES: O. RATE TOTAL Number Fixtures ...................... x $1.50 $ geo 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 /�j 1st 3 Fixtures .......................... x $1.50 $ J Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code 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, 1Vlinn°' 19L_1 Owner `; : %��1� 19— Kind of Building 19— Used as To be completed about Estimated Cost, $ -o Old—New. Building Permit No Sign By Business Phone No_ Description ...................................... $ TOTAL FEE �CJ 11 POST IM -12-58 3 Y K Z W a Z �O F N WATER HTR. GAS ELEC. Base 1st 2nd 3rd 4th • Future Connection Openings I New Fixture, Old Openings Connected with Sewer � Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE BATES: O. RATE TOTAL Number Fixtures ...................... x $1.50 $ geo 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 /�j 1st 3 Fixtures .......................... x $1.50 $ J Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code 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, 1Vlinn°' 19L_1 Owner `; : %��1� 19— Kind of Building 19— Used as To be completed about Estimated Cost, $ -o Old—New. Building Permit No Sign By Business Phone No_ Description ...................................... $ TOTAL FEE �CJ 11 POST IM -12-58 City of Fridley, Minn. BUILDING PERMIT N° 5503 Date: Owner:. Builder C00, Address Address UILDING No. Street W Part of .Lot _ Lot __ Block A dition or Sub.iWINft�� `�- Comer Lot _ Inside Lot i>ftback ideyard Sewer Elevation _ _� F dation Elevation DESCRIPTION OF BUILDING Toff Front Depth 01 Height Sq. Ft Cu. Ft Front Depth IT igt _ . Sq. Ft Cu. Ft Type of Construction •aR Est QF/4 . � �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 ordigreews of the city of Fridley. .4 In consideration of the payment of a fee of $ 34 -w` , 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 limitas and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. Z-2. NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to we the Building Inspector for separate permits for these Remo. :_ 0 APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY* MINNESOTA i owner's Name Builder Address Address LOCATION OF BUILDING No., ? Street art of Lot Lot— Block Addition or Subdivisio d back ide-Yard Corner Lot Insi a Lot 95t SEWER ELEVAT ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To used as: �) Front Depth71— Height �� Sq. Ft. Cu. Ft. FrontDepth Height Sq. Ft. Cu. Ft. Type of ConstructionEstimated Coee�/571 eV To be Completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and ruling of the Department of Build- ings, and hereby declares that all the factsrepresentations stated in this application are true and corre t � e DATE SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). OWNER'S NAME �Z/f/�L.c ���_/%•� BUII,DER ,•�/�/� ��� ADDRESS _ado aii - ",7 <ST"�%� ADDOSSadp _, LOCATION OF BUILDING No. Stteat Part of Lot. Lot I Block`' Addit.ionr or Subdivision Corner Lot Inside Lot Side -Yard SEWER ELEVATION FOUNDATION EUViTioN Applicant attach to this. form Two Certificates of, Survey of Lot and proposed build- ing 1ocation*drAwn da these.Cattificates. Yl 10, DESCRIPTION OF BtTII.DING 64 -71- J -0 4—/%J-0 1b be used As: �. Front Depth Height Sq. Ft.. Cu. Ft.. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost ..2o_be;_Cou9Leted s The undersigned hereby make 'application for a permit for the work herein specified, agreeing Co coo all work in strict accordance with the City of Fridley Ordinances and rulings if the Departmentof Buildings, and hereby declares that al°1•the facts and representations stated in this application are true and correct. SchedWA .of Fee Costs can be found on the Reverse Side) . 6 SUBJECT PER City of Fridley a 16402 AT THE TOP OF THE TWINS BUILDING PERM I T f RE `L COMMUNITY DEVELOPMENT DIV. `°II PROTECTIVE INSPECTION SEC. `� 1 � i CITY HALL FRIDLEY 55432 NUMBERREV, DATE PAGE OF APPROVED BY L J\ 612-571-3450 910-F15 9/23/81 JOB ADDRESS 6211 - 5th Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 31 2 Upland 2nd Addition SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Chuck Ruehl 6211 - 5th Street N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Chas. Johanson Inc. 424 Rice Creek Boulevard N.E. 571-8021 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 [INEW ❑ ADDITION X ALTERATION ❑ REPAIR MOVE ❑ REMOVE [I❑ X 8 DESCRIBE WORK Reroof Dwelling 9 CHANGEQFUSEFROM TO STIPULATIONS Roof can be the 2nd but not the 3rd roof. Install ridged 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 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 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1 000 $� rJ� 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- I ON OR THE PERF RMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE P� �- 5 ad $18.00 SIGNATURE OF CC3N ACTOR OR AUTHORIZED AGENT IDATEIWHEN PROPERLY VALIDATED THIS IS YOUR PERMIT BLDG INSP DAT SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATION FOR RESIDLNTIAL BUILDING PERMITS (New, Alterations, Additions, or Repairs) OWNER: ADDRESS: TEL NO: BUILDER: -10 ADDRESS: e, TEL NO: Construction Location STREET NO: �� STREET: nn LOT: BLOCK: ADDITION: LI-PLgk)h Q -AJ FU Corner Lot: Inside Lot: Setback.: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. Front: DESCRIPTION OF CONSTRUCTION Depth: Square.Feet: Cubic Feet: Front: Square - Feet: Height: Depth: Height: Cubic Feet: Type of Construction: Ae Estimated Cost: $ To Be Cbmpleted: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE REVERSE SIDE OF SHEET The undersigned hereby makes application for a permit for the work'herein specified, agreeing to do.all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true andc rrect. DATE: ` . SIGNATURE: i ' r .�- Stipulations: Effective Date May 1, 1988 CITY F FN E-LFY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 5.00 $ Future Fixtures $ 3.50 $ Old Opening, New Fixture $ 1.50 a Beer Dispenser $ WN $ Water $ 5.00 $ A $ ,5.00 ro 4 G Or. b 0 N Q $ &j:. 0. „x, w $ Sump or Receiving Tank Heater 5.00 au1 .-%1 ro $ ul m Hot Water Heater $ 3 w al $ 10.00 $ Gas Dryer $ 10.00 w wuei . . Yes ( ) No ( ) -ui Type R R $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS u� r 1% of Value of Fixture or u a4i State Surcharge $ .5o Reinspection Fee $ ($15.00) TOTAL FEE $ ks, Wo ii as lec m U a M m a a w vl w U m 40 :t u O Ran - 1st 2nd 3rd 4th (R) - Future Connection Opening Connected with Sewer (•) a New Fixture, Old opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 5.00 $ Future Fixtures $ 3.50 $ Old Opening, New Fixture $ 1.50 $ Beer Dispenser $ 4.00 $ 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 $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ Back Flow Preventer Required. . . Yes ( ) No ( ) Type $ 5.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance $ /S,00 State Surcharge $ .5o Reinspection Fee $ ($15.00) TOTAL FEE $ ks, Wo Job Address L;t j / 5 Department of Buildings City of Fridley Tel. 1571-3450 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 ok the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley. Mn. 3 I 19 () u OWNER _ �.u.A,e. KIND OF BUILDING USED AS TO BE COMPLETED ABOUT 3// /f ESTIMATED COST �&'q- go OLD - NEW BUILDING PERMIT NO. PERMIT NO. 1213n C3mpany ,-9&Wz-k1 -- S.:gned By ��Gr. ���� �� T!1. No. �V 4a 1 ROUGH INSP. 6-4 P. i FINAL INSP. Date APPROVAL FOR PERMIT -- 94F MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE I SUBJECT City of Fridley 2 8 573 AT THE TOP OF THE TWINS P E R M I T IrpRF:r. x.572-_3504 BUILDING jp+-IqIT ♦v _ COMMUNITY DEVELOPMENT DIV. 76 /� �l r PROTECTIVE INSPECTION SEC. 1 � NUMBER REV DATE PAGE OF APPROVED BY i 1 "'1 CITY HALL FRIDLEY 55432 612-571-3450 910415 11 13 98 JOB ADDRESS 6211 5th Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 31 2 lUplands 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Charles Ruehl 571-8315 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO L& L Contractors Inc. 151 Silver a d #7 New2 697-9455 20139 35 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 O ALTERATION Ox REPAIR O MOVE O REMOVE B DESCRIBE WORK Reroof house and garage (24 Sq) Tear -off 8 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST, OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN 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 1 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 $2056 $1.03 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- TRUCTION OR THE PERFORMANCE OF CONSTRUCTION $74.75 It FiA SC $2.06 PLAN CHECK FEE TO FEE /--- > � 9�� - --- �_- Lic C $ 0 $ .84 OF CO ACTO ORAUTMOAIZEDAGENT IOATEi IKB� HE PR VALID E HIS ISYOURPERMIT K f -/.3-�V S,GNATUgEOFOWNEp��FOWNER BUILDER, iDATEi 1h; -SP- I GATE I NEW- ,[ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress:�Z (( ST -ft S� • til ���� Legal Description: Owner Name & Address:, C,4A.-Ccs Tel. # S71 - 13 / S Contractor: G G �,-� �s ��� MN LICENSE # ��g9.735 Address: 151 F1vex &ze 2D 0-'7 Al2w Frig q Tel.# 6q -7-9N55 ' 5'51/ L Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: Length GARAGE AREA: Length DECK AREA: Length OTHER: DESCRIPTION OF IMPROVEMENT Width Height Width Height Width p Hgt/Ground - C7464 Sq. Ft. Sq. Ft. Sq. Ft. Construction Type: 'T-Cae-orr gFzeoF Estimated Cost: $rte;— 0?0S-6 (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: P/ /4%, Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: APPLICANT:? CITY USE ONLY Tel. # 697- 741S5 Fee Schedule on Reverse Side .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 [ ] CITY OF FRIDLEY PERMIT NO.: 2004-02112 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 11/18/2004 57L -36U4 YAX: (763) 571-IZ57 ADDRESS : 62116 ST NE PIN : 143024340041 LEGAL DESC : UPLAND 2ND ADD : LOT 8 BLOCK 1 PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION 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. # A/C UNITS 0 VALUE OF APPL OR WORK 0 # FURNACES 0 # GAS WATER HEATERS l # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALC) 300 APPLICANT NORBLOM PLUMBING CO 2905 GARFIELD AVE S MINNEAPOLIS, MN 55408-2173 (612)827-4033 OWNER BATES JAMES W & ROSE ANN 6211 6TH ST NE FRIDLEY, MN 55432 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 alter 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 regula 'construc r n or the performance of construction. Applicant / Date�� Bldg Insp HEATING PERMIT MINIMUM FEE 0.00 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 WATER HEATER - GAS 35.00 TOTAL 35.50 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY INSPECTION DIV. Effective April 1, 2004 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT - r. co (763) 572-3604, FAX (763) 571-1287 MARK NI IMRFR nl= FIXTI IRGC Tn RG IAICTe1 I cn ns1 CAf%u n nnc PLUMBING FIXTURE RATES: NO. RATE - mlmumffl JOB ADDRESS_ 6r0'enn.2. as OW A>er New Fixtures $10.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $10.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $10.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $10.00 and represe and correct. Catch 88SIn $10.00 BATES, JIM Rain Water Leader $10.00 6211 6TH STREET NORTHEAST FRIDLEY, MN 55432 ®� Sump/Receiving Tank $10.00 .20 (763) 571-1194 Water Treating Appliance $35.00 OWNER Water Heater -Electric $35.00 Water Heater - Gas`" �_ $35.00 �40- C0 BUILDING USED AS k�Si J e4 -I -Z PLUMBING FIXTURE RATES: NO. RATE - TOTAL JOB ADDRESS_ 6r0'enn.2. as OW A>er New Fixtures $10.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $10.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $10.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $10.00 and represe and correct. Catch 88SIn $10.00 BATES, JIM Rain Water Leader $10.00 6211 6TH STREET NORTHEAST FRIDLEY, MN 55432 ®� Sump/Receiving Tank $10.00 .20 (763) 571-1194 Water Treating Appliance $35.00 OWNER Water Heater -Electric $35.00 Water Heater - Gas`" �_ $35.00 �40- C0 BUILDING USED AS k�Si J e4 -I -Z Gas Range" $10.00 Gas Dryer*" $10.00 ESTIMATED COST q6 O � PERMIT NO. Back Flow Preventer Required ( )Yes () No Type $15.00 `` PLUMBING COMPANY O C \Ok aWlt U/UL` DV Reinspection Fee $50.00/Hr SIGNED BY TEL N0.; 6 $27- clo33 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance � Approved By Rough -In Date Final Date State Surcharge $ • TOTAL FEE jS, S0 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 50/6 OF COST $ OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. —PROVIDE COMMON VENT INFO ON BACK SIDE . 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. 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 alit 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 Slze/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 : Building Permit Fee BUILDING Z Permit No.: Z) - Inspections $ RESIDENTIAL APPLICATION Received By: 763-572-3604 $ CITY OF FRIDLEY Date Rec'd: DATE I �' S^ YOUR E-MAIL ADDRESS $ SITE ADDRESS co 2 .001 x Permit Valuation (1/10%) License Surcharge THIS APPLICANT IS: ❑ OWNER KONTRACTOR $5.00 (State Licensed Residential Contractors) PROPERTY OWNER/ NAME: 7` eDAJ/t AU -e A-1 h. TENANT ADDRESS: (o iL l I (J-- P'A 15,,- /yC_ CITY �/b: I- e -y STATE"_ZIP � PHONE::7 Cp 3 r? /-- 2151 Y' Erosion Control CONTRACTOR NAME: TW' n1 Cc!:!, �c.��i+► -t' � P�r1e cl e 1 } ..i.t, .l�/J G STATE LICENSE # EXP DATE ADDRESS: -77 10 i9+i� �'E , ,� �,,,I CITY �.(�f.lSTATE�"r�8'yl SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PH NE 7Cvl 1:79-^25'1^7 FAX $ PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCTION SIZE Total Due $ ❑ TWO FAMMY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH BiFOOF 0 DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIIvIIvHNG POOL TYPE OF WORK: ❑ NEW ❑ ADDITION MAINTENANCE/REPAIR❑ REMODELING DESCRIBE WORK BEING DONE: %flit. a4l— SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan 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 ❑ 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 $ OCCUPANCY TYPE Permit Fee $ Z See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Surcharge $ (.0005) times the total job valuation — Minimum $.50 Fire Surcharge $ `2 .001 x Permit Valuation (1/10%) License Surcharge $ Sr r'D $5.00 (State Licensed Residential Contractors) SAC Charge $ $1450 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $20 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ Make checks payable to: City of Fridley Attach Stipulations 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. SIGNATURE OF APPLICANT