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PRE 2010 DOCSVillage of Fridley, Minn. BUILDING PERMIT N? Date:.. `.57 .................. Owner �.. Builder .. ...... . i Address ... rf.o/ ... ... . .... .. Address ... � �.. ................. . t_ - LOCATION OF BUILDING No. .� . Street Y��,4��' ' ' ' ..'J 7 ............... Part of Lot e. f Lot .... ....... Block ...iK .......... Addition or Sub -Division ... ....... Corner Lot ........... Inside Lot ... � . Setback � Sideyard � DESCRIPTION OF BUILDING To be Used a : s %�,���® .. ..~!�:`"`°.... Front o ., Depth ..�� . Height _4�q. Ft. .. �.�.� Cu. �Ft. ........ I AA ... ........... Front : Depth Height . Sq. Ft. 4� - Cu. Ft. ........ p o7 Type o Construction Est. Cost . l a y( 00 L? a .... To be Completed ... 9.......... .. In consideration of the issuance to me of a permit to construct the proposed work in accordance with the description above and ordinances of the village of Fridley. ZZ6 0, In consideration of the payment of a fee of $../r ., permit is ng described above, I agree to do compli ce 'th1 rovisio of iGranted t z.. ............ .... 44 �e ......................... 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 with- in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. _ I NOTICE: This permit does not cover the construction, installation or alteration for wiring, plu I , gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these,s. City of Fridley r 4T TME TOP OP TM[ TWINa r'L'------- COMMUNITY DEVELOPMENT O1V, i PROT[CTIV[ WIftCY*M OW. l --- Cm MAIL PINDLCY 0602 s 5964 N. E. 6th. Street Robert De Vorr 53 -Bb -S-915.51 SWOMT PLUMBING PERMIT APPLICATION s rnone 560-1155 Contractor Address Phone MINNEGASCo /733 MARQUETTE AVENUE Kind of Building Use MPLS., MINN. Frame Res. Completion Date_'Estimated ost 3-6-7h 10.00 _Plumbing Fixture Rates: NO. RATE TOTAL � i W ;I Number Fixtures x $2.00 $ Future Fixtures x1 $ .50 MaNYa eve i New Fixture -Old Open. x $1.50 I ',ddVl I I O Catch Bastn x $3.25 cvo I , x„I Water Heater -99,000 BTU x $3.00 ']SIN I I I j! II Ground Run Old Bldg. x $3.25 •�nNlva I I I I I II m I Elec. Water Heater x $2.00 BI ! wN]1Y]I ” I I I ! W Gas Fitting Fees: IO G 8NIV80 I I I I b 3 o .w = aoo,AI i I •bG p, I 1st 3 Fixtures x $2.00 ,0v I .3 I SIMIAON$ V I I I I Additional Fixtures x$ .75 cl '1N Od I ( I I I NNING ao i Gas Range -199,000 BTU 1 x $5.00 5.00 Iq� NS INI I I I I Repairs & Alterations I See I I I I I Description: Code I sNISVY ; I _State Surcharge Classmq Surcharge .50¢ • 50 son.L I I I TOTAL FEE $ 5.50 M1Y6I I I I !The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work �a71 in strict accordance with the City Ordinances and Tulin gI M I I of the Department of Buildings, and hereby declare that all•the facts and representations stated in this m I I I I application are true and correct. Signator �h Date City of Fridley plfl %a W M1�� cmd G= Mrohl Pam Dept. of Bldgs. Phone 560-3430 DESCRIPTION OF WORK Number, Kind and Location of Fixtures Lota�s Ta NI3 _1 , 0 w �(jr¢7�j 3 F O 31 = �i V <3< l�ld t71 I N wArea Ms. GAS ELM Base 1st 2nd 3rd 4th • Future Connection Openings # New Fixture, Old Openings Connected with Sever Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures .......... ..:.... -3 x $2.00 $ �® Future Fixture Opening ........... x $1.50 $-- New -New Fixture Old Opening .....:.... . x $1.50 $ _ Catch Basin .................... x $3.25 $ Water Heater 'Up to 99,000 BTU) • • • • x $3.00 $ New Ground Run Old Bldg...... x $3.25 $ Electric Water Heater .............. s $2.00 = +AS FITTING FEES; NO. RATE TOTAL 1st 3 Fixtures ............ • • • x $2.00 $ Additional Fixtures ................. x $ .75 $ Gas Range to 199,000 BTU ....... ,...... x $5.00 6 City o1 Fridley: The undersigned hereby makes application for a permit for the- work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct' �j Fridley, Minn Owner 4j-e-� K • De [/O .e e Kind of Used as To be completed about Estimated Cost, $ Old New. Building Permit No. / Permit No. 6,;q - Signed 4 ,i / 1 4z ROUGH FINAL REPAIRS A ALTERATIONS•—Rotor to Code .50 State Surcharge . Description .................... •....................... -- ,, TOTAL FEE ' By Business Phone No ao-14C- City of Fridley AT THE TOP OF THE TWINS sueJEcr BUILDING PERMIT PE ����� r COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. 1 � i CITY HALL FRIDLEY 55432 612-560-3450 RlUMPT NO. NUMBER 910-F15 REV. DATE 10/29/74 PAGE OF APPROVED BY JOB ADDRESS 5964 6th Street N.E. 1 LEGAL DESCR. LOT NO. 3 BLOCK 4 TRA CT OR ADDITION SEE ATTACHED Bonny Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Robert Devore 5964 6th Street N.E. 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 ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Add.a 9 x 12 bathroom in basement 9 CHANGE OF USE FROM TO STIPULATIONS S.EPERATE PERMITS REQIRED FOR WRE4 HEATING, PLUMBING AND SIGNS4 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 AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION ZONING SQ. FT. CU. FT. 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 AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT VALUATION SURTAX 650.00 •50 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 PERFORMANCE OF CONSTRUCTION. $6.00 PLAN CHECK FEE TOTAL FEE ;,� 6.50 SIG _ E CONT '' OR SHO E AGENT (DATE) N PROPERLY VAL D THIS IS YOUR PE MIT SIGNATURE OF OWNER IIF WN RBUILDERI L (DATE) BLDG INSP A DATE` %I= APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAM • BUILDER: ADDRESS: ADDRESS: - NO:. STREET: na r -r -r- LOT: _ BLOCK: ADDITION: d AJ AJ'Y;14 Q. CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. To Be Used As: DESCRIPTION OF BUILDING Front: 41 Depth: i' -L, Height: �AmcwufrAj a Square Feet: [ () q, Cubic Feet: Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: !E_ Estimated Cost: $ Co S�•V� • To Be Completed: '7" *oA 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,anrca� y declares that all the facts and representations s edIn this apo are true and correct. ,. DATE: OcT' '! , I F% SIGNATURE •� (See Reverse Side For Additional Information.) SUBJECT P City of Fridley 21789 AT THE TOP OF THE TWINS BUILDING PERMIT 1-11/� I 1 7 l � ;COMMUNITY DEVELOPMENT DIV. L'-_---_ r PROTECTIVE INSPECTION SEC. I � I"'1 CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY A. "`j 612-571-3450 910-F15 4/14/9.3 JOB ADDRESS 5964 6th. Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 4 Bonny Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Orville Pauts.ch. 5964 6th Street NE 571-6507 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 ❑ NEW ❑ ADDITION ❑ ALTERATION J7 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House. X1.9. Squares:] Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayi4ent must comply with. the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1r G26 $,51 WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $27,00 Fire SC $1.03 STRUCTION OR THE PERFORMAN CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $28.54 'GN E 0 IfUTHORIZEDEAGENT IDATEIWHEN PRO t�RL�IDAT THIS IS YOUR PERMIT SSG ATURE r 01hA F owNER BUILDER) IDATEI LDG iNSR BATE NEW [ j ADDN [ j CITY OF FRIDLEY ALTER [ j SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: Legal Description: Effective 1/1/93 Owner Name & Address: OlylllP,Tel. Contractor: f �0w, a MN LICENSE # Address: LIVING AREA: GARAGE AREA: DECD 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. Comer Lot [ j Inside Lot [ j Type of Construction: Approx. Completion Date: Ft. Yd Setback Side Yard Setbacks Estimated Cost: $ / (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: APPLICANT: Tel. Tel. # CITY USE ONLY Permit Fee $ % vv Fee Schedule on Reverse Side Fire Surcharge $ L)..3 .001 of Permit Valuation (1/10th%) State Surcharge $ / $.50/$1,000 Valuation SAC Charge $ $750 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ j Not Necessary [ j 101100 STIPULATIONS: M4'es City of Fridley AT THE TOP OF THE TWINS SUBJECT BUILDING PERMIT PE2 7 0 3 ' , I i � _ COMMUNITY DEVELOPMENT DIV. L PROTECTIVE INSPECTION SEC. { � /'--1 CITY HALL FRIDLEY 55432 %.j 612-571-3450 RE O. NUMBER 910-F15 REV DATE 8/6/98 PAGE OF APPROVED BY 10B ADDRESS 5964 6 St I LEGAL DESCR. LOT NO. 3 BLOCK 4 TRACT OR ADDITION Bonny Addition SEE ATTACHED SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Orville Pautsch 5964 6 St 571-6507 3 CONTRACTOR MAIL ADDRESS ZIP Owner PHONE LICENSE NO. 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION XX REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Alum Roffit; 2 windows (living room & kitchen 9 CHANGE OF USE FROM TO STIPULATIONS 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 AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION ZONING SO. FT. CU. FT. 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 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED VALUATION SURTAX WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT .50 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 PERFORMANCE OF CONSTRUCTION. 9142.00 Fire SIC $.85 PLAN CHECK FEE TOTAL FEE 33.35 (DATEi WHEN PROPERLY V I ATED THIS IS YOPq PERMIT flTURICON)Tg��" BLDG ASP ` OATE SIGNATURE OF OWN R OF OWNER BUILDER) iDATEi NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: Legal Description: Owner Name & Address: Contractor: Address: t) A IJ 7-,5- c14 Tel. #— ,57/ S MN LICENSE # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Tel. # LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. F OTHER: U /1'j ,S 0 r'rr'T wov p caw s Construction Type: Driveway Curb Cut Width Needed: Ft. + 6 Ft = Estimated Cost: $ (-7 _;) C (Fee Schedule on Back) Ftx $ =$- DATE: O / 1s APPLICANT: 0AW— 4 � )Oq a Te- Tel. # TOTAL $ �f STIPULATIONS: CITY USE ONLY Permit Fee $ 0�-" Fee Schedule on Reverse Side Fire Surcharge $ �� .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1000 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 $ �f STIPULATIONS: CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 5"%2-36U4 VAN: ( 763) 571-1257 PERMIT NO.: 2004-00949 aa� DATE ISSUED: 06/22/2004 ADDRESS : 5964 6TH ST NE PIN : 233024210053 LEGAL DESC : BONNY ADD : LOT 3 BLOCK 4 PERMIT TYPE : ELECTRICAL PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADDITION/ALTERATION VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. REPLACE MAST AND REPLACE METER BASE. APPLICANT MR ELECTRIC 6451 MCKINLEY ST NE #E RAMSEY, MN 55303 OWNER PAUTSCH ORVILLE C & KLARA M 5964 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 after 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 worl 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 regulating construction or the performance of construction. Applicant Date Bldg Insp Date. ELEC AMP SERVICE FEE 30.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 30.50 PAID WITH CHECK # 2894 SEPARATE PERMIT'S REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 YAX: (763) 571-1287 ADDRESS 5964 6 ST NE PIN 233024210053 LEGAL DESC BONNY ADD LOT 3 BLOCK 4 PERMIT TYPE HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT 0.:2004-0168x, is DATE ISSUED: 09/28/20044 ' 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. INSTALL A FURNACE (WARM AIR, TRANS, 80,000 BTUS) # A/C UNITS 0 VALUE OF APPL OR WORK 0 # FURNACES 1 # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALC) 2476 APPLICANT TOTAL COMFORT HTG & AC 12800 HWY 55 PLYMOUTH, MN 55441 - OWNER PAUTSCH ORVILLE C & KLARA M 5964 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 after 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 worl 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 regulatin con ctio or the performance of construction. Applicant N `� Date_ Bldg HEATING PERMIT MINIMUM FEE 0.00 FURNACE SHELL/DUCT WORK 35.00 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 TOTAL 35.50 PAID WITH CHECK # 38423 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. M m T m M M M 0 F - w J 0 a: u - CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 1 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range P 6 /15 Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOBADDRESS5%)q Fee Total Owner��' $35.00 $ Building Used As(� ®. $10.00 $ ESTIMATED COST' PERMIT NO =Z()0L C� Gas Dryer $10 *Air Conditioning - AllSizes $25.00 $ 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 $300.00 LL- Commercdal/Industrial/Institutional 0 > 1.25% of Value of Appliance or Work (List on Back) ~ Minimum Fee $35.00 for Commercial/industrial/insUtutional U M U- 0) IT i0 IT C9 m N 1 Ui I State Surcharge TOTAL FEE REINSPECTION FEE $50.00/HOUR # of Heating Unit Circle One (Steam) (Hot Water) ( Trade me Size No. BTU HP EDR Fuel Total Connected Load Burner Trade Name BTU HP Size No. 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 *Air Conditioners can not be placed in sideyard wsthout written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE and representations stated in this application are true and correct. Tel # �Ci`t � 66 j �'—r3 FAX if =A\Dat Approved by _ Rough -in Date Final Date JUN -15-2004 16:49 FROM CITY OF FRIDLEY TO 3838500 P.03iO3 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. YeSX No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes O N )' 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 a^sisted and natural draft. appliances. Ye� No( ) The existing combustion air is sized and installed to meet the cur, ant codes and manufacturer's specifications. Ye) 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 () N q I When installing a new venting systern, the undersigned herisby verifies that it is a listed assembly and meets the current codes and maanufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () NOX Is the common vent and vent connrc4,01115 si7r� SrKl instalki -, l correctly after an appliance has been removed from the c cmmon vent and vented separately as per current codes. Yes ( No( ) Appliance Tvae and Size/Cornmon Vent and Vent Connector Information Appliance #1 T,_ BTU Input G O an Assisted or Nat f� I CLLS Appliance #2 Type Input `3 i ' Fan Assisted or Nat Appliance #3 Type BTU Input 7 Fan Assisted or Nat Total Appliances Total Btu Input f Common Vent Type Vent Height �� Diameter inches Appliance #1 Vent Connector Height Length j,5 ft Diameter in Types 10JA 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 TOTAL P.03 ."ITY OF FRIDLEY INSPECTION DIV. 1431 University Ave NE 'ridley, MN 55432 763) 572-3604, FAX (763) 571-1287 Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT ®� r ©I /1U MAKK I UMBEK OF FIXTURES TO BE INSTALLED ON EACH FLOOR Will_ >< Urinal ......:............. _ ::::Sh w r ............... o e ~ .............:.::. as Tra :::<::: r Floor n :.�>:�:;:::::: Auto. :.:....�-.......I< Washer .�''s-�;<.:::::<::;; �:. �::.>_: Gas Range �;,::� �:�>: Water Heater 'tori e s �< Gas Elec Basemen _<> Floor 1 0 Floor 2 Flo r 3 0 Floor 4 'LUMBING FIXTURE RATES: Jew Fixtures )Id Opening, New Fixture 3eer Dispenser flow Off Basin ;atch Basin Iain Water Leader iump/Receiving Tank Vater Treating Appliance Vater Heater -Electric Vater Heater - Gas** NO. RATE TOTAL JOB ADDRESS_ 60M_A2 a.S 0'I.c) AJ V - Sas Range** Sas Dryer** Sack 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 teinspection Fee $50.00/Hr kLL 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. STODLOKA, MIKEv 5964 6TH STREEN NORTHEAST O 20� FRIDLEY, MN 55432 OWNER (612) 819-0064 BUILDING USED AS kcSI d eMGe_ ESTIMATED COST q6 Ll oto PERMIT NO. PLUMBING COMPANY D (_ Y0` 0VA C1✓1M IOt SIGNED BY 0044, .01 TEL N0. Ayl?) 827-5/033 Approved By Rough -In Date Final Date MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST $ �S OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. '*OMBUSTION 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 existina 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 installina 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 C�00�- .0- 0'*5q NEW [ ] CITY OF FRIDLEY Effective 1/1/2002 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: n V4 6-10 3+ U E Legal Description: 1 Owner Name & Addr ss ®l�� LL�bq�p�� Tel. # Contractor. u T MN LICENSE # Address: 9�4;5 "�+ "::4-0. l0Q Tel. # i 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: �6®19 (Z(s (5�- Construction Type: o nim r oc Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $] —=$ L 1 DATE: ,[ APPLICANT: Tel. #C%i qb qL) Call (763) 572-3604 for Permit Fees if mailing in application or Fax to 763-671-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee $ 83 -QS_ Fee Schedule on Reverse Side Fire Surcharge $ - .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ Sv $1200 per SAC Unit License Surcharge $ 6-. X) $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 $O rZ� ®�'f STIPULATIONS: