The URL can be used to link to this page

PRE 2010 DOCSBUILDING PERMIT Village of Fridley, Minn. No 2 R 7 9 Date ��Y'4. k2,. Z4R7V................ . Owner ..� Builder .... Address....10 zQi .Q .... d ress ....... ................. LOCATI N OF BUILDING ..Street ........ ....... .............Part of Lot ....................... �/7r� ..... Block ................ Addition or Sub -Division ... al ................. �22 Corner Lot ............ Inside Lot ............ Setback . o-?0� ..... Sideyard ............... DESCRIPTION OF BUILDING T Used s: o .. .... Front . �f ... Depth 9. A .... Ueight Sq. Ft. .... Cu. Ft. ........ .................... Front ........ Depth .... Height ......... Sq. Ft......... Cu. Ft......... Type of Construction FAM M... Est Cost ..�.7� �% ® U. ®`!..... To be Completed.. ' �?3 ......... pjA, PLa-�� In consideration of the issuance to me of a permit to construct the building the proposed work in accordance with the description above set forth and in cc ordinances of the village of Fridley. I above, I agree to do with all provisions of consideration of the payment of a fee of $1XMI!q, 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 Cher s conform in respects to the ordinances of Fridley, Minnesota regarding location, construction, alt ation, ma' ten Tolyopn0 ' d moving of buildings with- in the village limits and this permit may be revoked at any time u on8 y of the provisions of said ordinances. I' .. .� ...,,,/.,?,-Building Inspector NOTICE: This permit does not cover the construction, Installation or alteration for wng, plumbing, gas heating, sewer or water. Be sure to see the Building Inspeollr for separate permits for these Items. I y *City of Fridley, Minn. BUILDING PERMIT N° 4333 � s Date: .......... A_......_...._.... .......... _.._._.._.... _.. Owner: .......................... ..................................... ......... _.......... _............ _.................... Buildere,1_........._...........1J...zj^....... __.. Address ...... ................. Address _ //��LOCATION OF BUILDING No...----- ..�..L...1 Street ....._.. ._..... = .. Part of Lot ............................ _. _. _.. y........._..., ..................._..--------- -_ ......._ ck Lot a?.Y.'-'.3.0131ock .............. ..... j ................ .---------- Addition or Sub -Division ... 1.. ..................... ._......... ......................... - -._� _ Corner Lot ... .......................... Inside Lot ----------------- Setback .................... _....................... Sideyard................................................... ............. ... _.._ Sewer Elevation To be Used as: Type of Construction -.. Foundation Elevation DESCRIPTION OF BUILDING Front .;Z;'...6_VDepthri�.�)�.� ,Height <...._ Sq. Ft..�Vrko cu. Ft.1..._.4.....�® Front - -- Depth........./mei ht .......�....... Sq. Ft ........................ Cu. Ft. ....................................................... Est. C s6. t %`.. � ........... To be Completed ........................ In consideration of the issuance to me of a permit to cons ct the the proposed work in accordance with the description above se ordinances of the city of Fridley. I agr to do -Pfo-visions of In consideration of thea p yment 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. , 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. 4 APPLICATION FOR BUILDING PERMIT CYTY OF FRIDLEY MINNESOTA Oc'mers N Builder Address _ 1. �, Address. L - "4^ LOCATION OF BUILDING No. 3'L 7/- Street, // Part of Lot Lot 9 �� Block` �` ^� Addition or;Sub.Div CornerLot v""Inside Lot Set Back Side -Yard SE6aEB. ELEVATION FOUNDATION ELEVATION Applicant at to this form Certificate of Survey.of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: Front C -5t e Depth Height �n� Cu., Ft. S .� rt. ICU, Front Depth Height Sq. Ft. Cu. Ft. S"Type . q£ Construction_-ls��--�� Estimated Cost To be completed The undersigned hereby makes application for a permit for the work herein.speeified, 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 J SIGNATURE (A Schedule of Fee costs can be found on the Reverse Side.) r • City of Fridley, inn BUILDING PERMIT Date: dura- 2, i 96s Owner: i1chard Leslie Address 5671, 6th, Street N. E. Builder N° '7662 P. D. Q. Claim Service LOCATION OF BUILDING No. 5M— Street 6th. Street N. E. Part of Lot Lot 29=30 ..._ Block 1 Addition or Sub -Division .HMU&0n Corner Lot Inside Lot Setback Sewer Elevation To be Used as: Type of Construction Sideyard Foundation Elevation DESCRIPTION OF BUILDING Front — _ Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Est. cost :0 _ To be Completed • Storm damage repair • 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 ab set forth and in compliance with 21 provisions of ordinances of the city of Fridley. p In consideration of the payment of a fee of permit is hereby granted to P. D. Q. Gla3p1 Service 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 ordinanozs of dleyR , Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings an city limits and this permit may be revoked at any time upon violation of any of the provisions of said Alleva Jmsea Building inspector NOTICE Me pwn* don mat eover the conshve8m, haft9a om for wMmg, phmbtmB, en ham& sewer er wafer. Be wre to we the swMime kqm ter for wpvaM permdb for thea home. APPLICATION FOR B'- ING PERMIT CITY OF FRIDLEYy CNNESOTA OWNER S/ i _ j, LOCATION OF BMDIW No. Stteet Part of Lot. Lot �1 �Block _ Addit.ioar or Subdivision Corner Lot Inside Lot _, •.$et.V4tk Side Yard SEWER ELEVATIpN FOUNDATION EL$V'ATION Applicant attach to thit form, Two Certificates of.Survey of Lot and proposed build- ing location drAwn oft these LA-rtificates. To be used as: DESCRIPTION OF BUILDING Front Depth Height 94. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu ..Ft . , Type of Construction Estimated Cost 1712- ..-To-,be 7a..-To-be -Completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to Ao all work ift 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 and correct. jSchedule of Fee Goats can be found on the Reverse Side). Y _ 1C11Cf %9-0057 $. x, FILE NO: r 196 it I.Z r w 6-1 IA A. ci P G �k x f . ®r SUBJECT P City of Fridley 28022 AT THE TOP OF THE TWINS BUILDING PERMIT R O. • _ COMMUNITY DEVELOPMENT DIV. O r PROTECTIVE INSPECTION SEC. NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 L J` 612-571-3450 910415 9/29/98 JOB ADDRESS 5671 6th Street NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED OESCR. 29, 30 1 Hamilton SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Dave Berry Const. Inc. 20625 Co. Rd. 30 Corcoran MN 55374 420-8628 20 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 ❑ ADDITION ❑ ALTERATION YM REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage (22 Sq) Tear -off 9 CHANGEOFUSEFROM 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 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 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 $1885 .94 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- CTION OR HE PER MANCE OF CONSTRUCTION $59.50 Fire SC 1.88 PLAN CHECK FEE TOTAL EE 1 ' / 6�r9� Lice S $5.20 67.32 SIGNATURE OF CONTRACTOR OR 4WOtHORIZED AGENT IDATEr EN ROP ALIOATE IS IS T BLO --NSP �rAtE 1 SGNATURE OF OWNER OF OWNER BUILDER, ,DATE- ®r NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION n� a ConstructionAddress: 7 �Q 5 (`•� (a Legal Description: Owner Name & Address: Tel. # Contractor: ,(' iiU (�- e2s6-z L-2� Cv I`►MN LICENSE # Address: 4'0(03-S L') �4 -30 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 GARAGE AREA: Length Width Height DECK AREA: Length --�- Width Hgt/Ground OTHER: �?, Sq. Ft. Sq. Ft. Sq. Ft. Construction Type: 1'Z61� i` � &PF Estimated Cost: $ B Ojos (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: APPLICA1W.-0 Tel. # Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: S CITY USE ONLY 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 $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ J SUBJECT O. City of Fridley 30574 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. fr __�___ COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. 7696 r PROTECTIVE .—I � CITY HALL FRIDLEY 55432 �'' NUMBER REv DATE PAGE OF APPROVED BY 612-571-3450 910415 12/8/99 JOB ADDRESS 5671 6 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 29,30 1 Hamilton's Addn to Mechanicsville SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Dory Connolly 5671 6 Street NE 586-9622 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Renewal By Andersen 350 73 Ave NE, Fridley, MN 55432 502-4777 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 20130983 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW O ADDITION ❑ ALTERATION 3P REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Replace 6 windows and 1 bay window in existing openings 9 CHANGE OF USE FROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Portrait lnspo,ctlo� Carus Will Be mailed To Homeowner To Post 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 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT Ri 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 @ $3.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $6,000 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- Fie SC $6.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $125.25 PLAN CHECK FEE TOT FEE Licen C $5 $139.25 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEie�o-`E)(PRI710 ALI T rHIS I�� PERMIT S,GNATURE OF OWNER .-F OWNER BUILDER, DATE. 7�J BL G MATE NEW[ ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER pcj SINGLE FAi1D,Y AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Legal Description: Owner Name &Address: -Z01 C.6n6rj, Contractor: RENEWAL BY ANDERSEN 350 -73RD AVE. NE Address: FRIDLEY, MN 55432 (612) 50204777 LICENSE #20130983 Tel. # &In? •��4 • �(oa� MN LICENSE # Tel. # of Survey of the wn on it to scale. DESCRIPTION OF DMPROVEAMNT 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: �,�Q w ��..�;.,� .mac �� `: • � Estimated Cost: $ 00-1 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ 4DATE: lo?- (0 -91 APPLICA NT: Tel. # ff /� �j,x25 O CITY USE ONLY jy7 TOTAL $ STIPULATIONS: Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ oo .001 of Permit Valuation (1/10th!) State Surcharge $ ��— $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ E c,5c> $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: 05- Qos-'®D� NEW [ ] CITY OF FRIDLEY Effective 1/1/2003 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 Construction Address: 0(4,-7 ) G -h a+ - N E - Legal Description: Owner Name & Address: N r LA CO Y) n o 1l La Tel. # Contractor: D17UJid `JC h uJi" &nSWlCshrm MN LICENSE # 02 ate, Address: d/-2 tfo Pte/ P kz�. ka un W c-�SW+el. # 9 S'�1469'5 o --- LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. Construction Type: JE�6,Qry-r- Estimated Cost: $ . `700 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 09 G APPLICANT: Tel. # 91 `" 1 z S- 3 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. CITY USE ONLY - Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1275 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Curb Cut 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: NEW [ ] CITY OF FRIDLEY Effective 4/1/2004 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 Construction Address: �� I cii s�k LJS n E I' • - - : ••. - 78a, - r r�� • - , i ' _ allMN LICENSE# 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:I':X�tX� ��'.�� Estimated Cost: $ I O) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE:..I-((- APPLICANT: tj-&J&4Lt IDB&eka Tel. # 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. CITY USE ONLY - Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge $�3 Fee Schedule on Reverse Side 65%.of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering, Agreement Necessary [ ] Not Necessary [ ] TOTAL $ �'�% co e a� STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV. ano S- -®/a2 / / Effective April 1, 2004 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT (763) 572-3604, FAX (763) 571-1287 MARK NI IMRFR C11: MYTI IRFR TO RF INRTAI 1 Fr) ON FACH FI nnR PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin NO. RATE TOTAL 0 Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** Gas 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 JOB ADDRESS 5& 71 (� 4 St IVE 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. DATE: -7 --d 5 ` ®S , 20 a "S OWNER✓'Gi �r�o tiu BUILDING USED AS ESTIMATED COST PERMIT NO. PLUMBING COMPANY nfD SIGNED BY �� . ��` — �69� TEL N0.7�' � "� I � Approved By Rough -In Date Final Date $ .50 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 Urinal <> Shower 1>`> Wash := I r IItI>:»::: Foo......5€::::.....*.::::: ...?�1.......... Drain :::>: •��`�•��••>'�...... �� .......... Auto. Washer s :::::: ...:........ Gas Range water Heater Stories 'w).t�a<;::: .. �>..... Gas Elec <` ':<`` Basement ��:.:::::::<..<..::::. r Floo 1 Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin NO. RATE TOTAL 0 Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** Gas 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 JOB ADDRESS 5& 71 (� 4 St IVE 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. DATE: -7 --d 5 ` ®S , 20 a "S OWNER✓'Gi �r�o tiu BUILDING USED AS ESTIMATED COST PERMIT NO. PLUMBING COMPANY nfD SIGNED BY �� . ��` — �69� TEL N0.7�' � "� I � Approved By Rough -In Date Final Date $ .50 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 't FILL IN COMPLETELY FOR REPLACEMENT FUEL BUFMING APPLIANCE PERMITS COMMON VENT; VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, the undersigned hereby verifies that the BTU Input venting has been examined and is free from rust, deterioration, obstructions, Appliance #2 Type and is securely supported and firestopped where required. Yes () No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer BTU Input specifications including sizing, length, number of elbows and terminatidn. 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 Vent Height include AGA-GAMA Category I Central Furnace Venting Tables for fan Appliance #1 Vent Connector Height assisted and natural draft appliances. Yes( ) No ( ) The existing combustion air is sized and installed to meet the current codes ft Length and manufacturers specifications. Yes ( ) No( ) When required to install a new combustion air, it will be sized and installed ft Diameter in Type 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 manufacturers; specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. 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 : a; o®�-- 0 092 Building BUILDING Permit No.: - 82 a Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: !® DATE G YOUR E-MAIL ADDRESS SITE ADDRESS THIS APPLICANT IS: ,OWNER ❑CONTRACTOR PROPERTY OWNER/ NAW: DOVV TENANT 56 ADDRESS: CITY —'IF®® STA IP r7T PHONE. -M 3 961 b h 7, L eAl D CONTRACTOR NAME: SUBMIT A COPY OF STATE LICENSE # 1 EXP DATE YOUR STATE LICENSE ADDRESS:ti CITY STATE—ZIP— TATEZIPWITH WITHAPPLICATION PHONE FAX PROPERTY TYPE Iff SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS grBASEMENT FINISH ❑ ROOF 49 DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SW VRVIING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION 1 14 MAINTENANCE/REPAIR WREMODELING DESCRIBE WORK BEING DONE: IAT ;V, : � A� SIZE OF IMPROVEMENT LENGTH LQ`__ WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan PROPOSED SIZE: ❑ DETACHED GARAGE 2. 3. Proposed floor plan 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 $ 1.Jr00 • D® OCCUPANCY TYPE Permit Fee 11 $ 6 41 AO See Back Page for Fee Schedule Plan Review Surcharge $ Fire Surcharge V Di) / License Surcharge $ SAC Charge ,� l/ $ Curb Cut Escrow Erosion Control �8r Park Fee Sewer Main Charge $ Total Due $ 65% of Building Permit Fee (.0005) times the total job valuation — Minimum $.50 .001 x Permit Valuation (1/10%) $5.00 (State Licensed Residential Contractors) $1450 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$20=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work whicl re vires re wand proval of plans. ��[[ 1 j� ( / SIGNATURE OF APPLICANT PRINT NAME EJ LU OL /— y. b 0 19 DATE 2 v ��"� �/ ) 6 rn ) -I r— M t) ti z 7k t i tet. M -V,