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PRE 2010 DOCSSUBJECT - PERMIT City of Fridley 15 1 8 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT O. • L L — _____ COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. 3 OL o 1 � � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L 612-571-3450 910-F15 5/27/81 10B ADDRESS 6810 - 7th Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 3 Rice. Creek Terrace. Plat 4 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dick Fishback 6810 - 7th-Street N.E. 574-0126 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. L. Gudmunsen Construction Inc. 1410 Coon Rapids Blvd. 757-3557 4 ARCHITECT OR DESIGNER MAILADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑� ❑ NEW X ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 20s x 18' Addition to Duelling 9 CHANGE OF USE FROM TO STIPULATIONS Variance approved on May 12, 1981 to reduce the side yard setback to 8.8 feet. Provide outside combustion air. Provide a products of combustion fire alarm. WARMS 10 SEPERATE PERMITS REQUIRED .FOR W IRI �r Beige digging call local utilities HEATING., PLUMBING TELEPHONE -ELECTRIC - GAS Etc. AND Sl(;tl& REQUIRED BY LAW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, Wood Frame 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 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 $13,100 $6.55 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $81.00 NONE STRUCTIO R THE PERFORM CE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE ATE) $20.25 $107.80 SIGNAT OFCONTRA OR OR AUTHORIZED AGENT WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT "n° BLDG )NSP TE SIGNATURE OF OWNER I IF OWNER BUILDER) IDATEI CITY OF FRIDLEY APPLICATION FOR RES IDI:NTIAL BUILDING PER14ITS (New, Alterations, Additions, or Repairs) O1dtdER:. ... BUILDER: c�> o..is��p�,� ADDRESS. 1 b I+L% S•{ • 1'l.� ADDRESS: / Y/O �me.•J ,('ro�s %3/y �. TEL NO: S2Y — D/ i- (o. TEL 110: `l, 7— 35S 7 Construction Location STREST NO: Co S / O STREET: -�I� "k-. VU • . LOT: � � BLOCK: s'� .3 ADDITION :��, � A 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. DESCRIPTION OF CONSTRUCTION _ /� / Z7�h = uv t $C/6=ITT y �G0� �dla,�Front: ad — pit Depth: �- OHeight: JZ Square. Feet: Xt Cubic Feet: Front: Depth: Square - Feet: Cubic Feet: \'>, o% .SL --� 1- O. I o u Height: do Type of Construction. W e a ,(Z,or,,, Estimated Cost: To Be ODmpleted: c1 C3 C z _ Alt. A Alt. B Proposed .Driveway Width If New Opening Is Desired: SEE REVERSE SIDE OF SHEET Vne undersigned hereby makes application for a permit for the t:nrk' 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 representa.ti.ons stated in this application are true and coWrect. D7=3: s -/-L f. / 4I SIGNATUI%'&: Stipulations: � P ?/.00 Gj WiZ,W/gr p� 2a.2J' Cisomg. c� (� � � •� �2avvp� PQ�o�� o9•� ° C'cjvuV oW7�w rfA,.F CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE RESIDENTIAL Furnace Shell and Duct Work, Burner Gas Piping (piping needed with new furnace) Gas Range Gas Dryer Air Conditioning (all sizes) RATE TOTAL $ 20.00 $ $ 10.00 $ $ 10.00 $ $ 10.00 $ All Others/Repairs and Alterations 1% of Value of Appliance or Work COMMERCIAL/INDUSTRIAL 1% of Value of Appliance or Work $ 10.00 $ State Surcharga 0�-t� Reinspection Fee ($15.00) Rough Insp. Date Final Insp. Date Approval for Permit ®® ® 7— MINIMUM FEE FOR ANY HEATING PERMIT IS $10.00 PLUS $.50 STATE SURCHARGE Effective Aug. 1, 1981 cy i-74A �91 i Job Address ( py l 0 � TA ST r e GN.C. � + ®�{ a C. Department of Buildings, 6431 University Ave. N.E., Fridley, NIDI 55432 City of Fridley Tel. #571-3450 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 of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. OWNER $ KIND C USED AS $ Attach stack verification form with replacement furnace permits Fridley, Minn. '? _q . 19JQ TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. &31 DESCRIPTION OF FURNACE/SURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Trade Name ( Size Mo. Capacity Sq. Ft. EDR BTU HP Total Connected Load Kind of Fuel N. BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Company Signed By Tel. No .-7 7 -' �� J SUBJECT PE City of Fridley 1866 AT THE TOP OF THE TWINS BUILDING PERMIT _ r? L RECEIPT NO. `v ------- COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 ' � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 9/30/86 JOB ADDRESS 6810 - 7th. Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 3 Rice Creek Terrace Plat 4 SHEET 2 PROPERTY OWNER MAILADDRESy ZIP PHONE Richard Fischbach 6810 - 7th. Street N.E. 574-0126 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION] ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS Roof can be the 2nd layer but not the 3rd. Install ridged galvanized valleys. 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 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 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 $900 $.5O 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- $16.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $16.50 SI NATURE OFCONTRACTOR ORAUTHORIZED AGENT (DATEIWHEN PROPERLY VA TED THIS IS YOUR PERMIT + BLDG INSP ci c nA_TE SI NA UREOFOW RIIF WNER BUILDERI (DATE) J NFA [ ] City of Fridley Effective 4/1/8( ADDN . [ ] R-1 AND R-2 ALTER. [ 7 Building Permit Application Construction Address: Legal Description: ` ' Owner Name i Address: R� a�� Sc baO-k/\ Tel. 1 S7 -C" Contractor:Tel. Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Corner Lot [ ] Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. Length Length Length Inside Lot [ ] Type of Construction: Approx. Completion Date: DESCRIPTION OF IMPROTEMEM Width Width Width Height Height Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. _— Ft. Yd. Setback __ Side Yard Setback Estimated Cost: $ [ �'�- Alt. A Alt P Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE. �(� � APPLICANT: ., Tel. 0 CITY USE ONLY Permit Fee .ti<%�'F Fee Schedule on Reverse Side Plan Check i 25% of Building Permit Fee State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $475 per SAC Unit Park Fee $ Fee Determined by Engineering Sewer Hain Charge Agreement Necessary [ ] Not Necessary [ ] TOTAL` STIPULATIONS: SUBJECT PER City of Fridley 22055 AT THE TOP OF THE TWINS BUILDING PERMIT r 1 , O COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. �� -7a r 1 CITY HALL FRIDLEY 55432 NUMBER REVGATE PAGE OF APPROVED By 612-571-3450 910-F15 8/25/93 JOB ADDRESS 6810 7th Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 3 Rice Creek Terrace Plat 4 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Richard/Kathy Fischbach. 6810 7th Street NE 574-0126 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Franzen Construction 4250 5th Street NE 788-4071 2744 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 O NEW f� ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a. 61 x 23'�.Garage Addition 9 CHANGEOFUSEFROM TO STIPULATIONS See notations on plan. Provide a hard surface driveway. WARNI14G Before digging Call for all utility locations 454-0002 REQUIRED BY LAW 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 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES 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 $15 5q0. $7. 75 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT r 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- $171.00 Fire SC $15.50 STRU7 OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE -)-5-9?�'License S $5. 0 $199.25 SIGN ATUR O CO N TRACTOR OR VT.ORIZED AGENT (DATE) WH R PE VALIDATED THIS IS YOUROPER IT BLDG INSP 2F qAT SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) NEW [ J Effective 5/26/93 ADDN [ J CITY OF FRIDLEY ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit. Application Construction Address: C0610 -74k, S -r - Legal Description: Owner Name & Address: f�j Contractor: NP ZE Address: 6-, c b ft k1 41tN k r3�ca -1 Tel. #:574-o C� MN LICENSE #.� Tel. # 73'SVA 1 I Tel. Attach to this application, a Certificate of Survey of the CITY USE ONLY Permit Fee lot, with the proposed construction drawn on it to scale. Fee Schedule on Reverse Side Fire Surcharge DESCRIPTION OF IMPROVEMENT .001 of Permit Valuation (1/10th%) LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length 3 Width Co Height I 2.' Sq. Ft. 1&9— &9DECK DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Corner Lot [ J Inside Lot 0- Ft. Yd Setback 32 .A, Side Yard Setbacks ,2.8 -r7- Type r7-Type of Construction: Ox—amt A by ru o x) Estimated Cwt: $ 0(f) Approx. Completion Date: - 31 - 3 (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: APPLICANT: Tel. CITY USE ONLY Permit Fee $ �/ , `J Fee Schedule on Reverse Side Fire Surcharge $ 1'S .001 of Permit Valuation (1/10th%) State Surcharge $ 7 ' $.50/$1,000 Valuation SAC Charge $ — $750 per SAC Unit License Surcharge $ 'S $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Aft. "B" Above Erosion Control $ Conservation Plan Review $450.00 Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary (J Not Necessary ( J TOTAL $�® STIPULATIONS: SUBJE& PER City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT 90 5 I? ` RECEIPT NO. `COMMUNITY DEVELOPMENT DIV. v______ PROTECTIVE INSPECTION SEC. r NUMBER REV DATE PAGE OF APPROVED By CITY HALL FRIDLEY 55432 L J` 612-571-3450 910415 3/23/99 JOB ADDRESS 6810 7 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 3 Rice Creek Terrace Plat 4 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Fischbach 6810 7 Street NE 577-0126 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE'NO Kallerup Construction 1602 Archwood Rd, Minnetonka, MN 55305 545-4921 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 7591 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION CR REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (28 Sq) Tear-off 8 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to 9:00 pm on Saturday; No work on Sunday. SEPARATE PERMITS ARE REOUIRED 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 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 $1.20 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,399 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. $74.75 Fir/)SC $2.40 STRUCT N OR TME PERFORMANCE OF CONSTRUCTION PLAN CHECK FEETOT L EE Licens C $5.0 $83.35 SIGNATURE OF CON'RACTOR OR AUTHORIZED AGENT (DATE, HE PROP VALID THIS OUEgMl7 YR S.GNATURE OF OWNER,11' OWNER BUiLDERi iDATE, BL G NSP - nAIE NEW [ ] Effective 1/1/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION �o�� ConstructionAddress: Ce G 746 � 1 ` /v . C Legal Description: Owner Name & Address: Contractor: Kk 1/o -- Address: /c Address: (,b - 2- (I- (, 4'*`- V C Tel. # MN LICENSE S30S Tel. #� 4-1 cl 2 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: Len Width Hgt/ round Sq. Ft. r OTHER: ype Construction T Ti,c r- , o Il�� f �Estimated Cost: $ 023 qa (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: Q)3 /ZLC(APPLICANT: � �Tel. # 25/— CITY USE ONLY Permit Fee $ - S� Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ S,06 $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: CITY OF FRIDLEY INSPECTION DIViSION Effective On January 1, 2002 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, ��(P (763) 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS 49A/O 70 _3-% AbE RATE SCHEDULE OWNER Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer 6_A4,j-Ia__<_ *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1%n of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Rate TOTAL , B � BUILDING USED AS $ 30.00 $ ESTIMATED COST PERMIT NO. - $10.00 0.$10.00 $ DESCRIPTION OF FURNACE AND OR BURNER $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $ 10.00 $ Trade Name(,t /�� &f Size No. 25.E BTU 9 vie, HP EDR $ 25.00 $ Fuel Total Connected Load State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. -� F $ .50 $A5-. _-�-d e Ccl"' e c� , Rd. rt Burner Trade Name Size No. BTU 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 an rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE c:Z<"'- HEATING CO Signed ��%�� TEL # FAX # Approved By Rough -In Date Final Date q' L� •C1'), THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED When ralarino an Pxinhng fumam, 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 plasticlPVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes( ► No( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturers specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes( ) No ( ) The rpxecting r_omh action air is sized and installed to meet the current codes and manufacturers specifications. Yes( ) No( ) When required to install a new cemhustien_ air. it will be sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When lanstallonn a new ventingevc� _#em, 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 Zyne and -'67P/Common Vent and Vent Conn actor 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 HEATING CO: Signed By: Date: '#ITY OF FRIDLEY INSPECTION DIV. Effective April 1, 2004 431 University Ave NE / -ridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 763) 572-3604, FAX (763) 571-1287 MARK NUMBER OF FIXTURFS Tn RF WRTAII i Fn nM GArN m nno ILUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 54nnn.2 • a.S aw N� Jew Fixtures $10.00 The undersigned hereby makes application for a permit for the work herein )Id Opening, New Fixture $10.00 specified agreeing to do all work in strict accordance with the city codes Seer Dispenser $10.00 and rulings of the Building Division, and hereby declares that all the fads flow Off Basin $10.00 and representations stated in this application are true and correct. ;atch Basin $10.00 RICHARD 1015 0 Iain Water Leader $10.00 . 6810 7TH ST 6810 7TH STREET NORTHEAST 20 )ump/Receiving Tank $10.00 FRIDLEY, MN 55432 Vater Treating Appliance $35.00 OWNER (763) 574-0126 Vater Heater -Electric $35.00 Vater Heater - Gas** $35.00 ��>> BUILDING USED AS Sas Range*" $10.00 las Dryer** $10.00 ESTIMATED COST �� o^o PERMIT NO. 3ack Flow Preventer Required ( )Yes Type () No $15.00 `_ ` t PLUMBING COMPANY O � p1 OVA ► 1, W1M.1DVn4q, teinspection Fee $50.00/Hr kLL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge TOTAL FEE SIGNED BY Approved By Rough -In Date TEL N0. N12) 927-cl033 Final Date MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST $ Ls.Sb 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 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 : Building BUILDING PermitNo.: A10 -13A Inspections RESIDENTIAL APPLICATION Received By: A 0K 763-572-3604 763-502—))4977 CITY OF FRIDLEY Dat dMRv 2 2 2010. FAX EFFECTIVE 1-I-2010 DATE _S E-MAIL DRESS S A U/ 1 PV m , /!� SITE ADDRESS �Y—OUR i< , Ie P S THIS APPLICANT IS: ❑ OWNER �qVOCTOR PROPERTY OWNER/ NAME:SC C ' TENANT ADDRESS:CM CITY / ' to y� STA ZIP S,S '7 ��11S PHONE: - V CONTRACTOR NAME: d 006P SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # �L EXP DATE 3 ' 2)• a? AND CERTIFICATE OF ADDRESS: ley CITY ~ / STAT ZIP INSURANCE PHONE M— I FAX PROPERTY TYPE A3,SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHEDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION E-MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: ( 1 f .S S l.Z SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 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. 2. Two sets of construction plans WINDOWS IN EXISTING OPENINGS IrYes ONo LOCATION OF WINDOWS 3. Energy Calculations FOR WINDOWS — PROVIDE U -VALUE AND OR FOR NEW OPENINGS -DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED - L1- NUMBER OF WINDOWS V ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: SING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ OCCUPANCY TYPE Permit Fee $ J e� j See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ 91 .001 times the total job valuation Surcharge $ 1.0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $2100 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $24 = $ 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 on site; that the work will be in accordance with the approved plan in the case of Awork which req eplreview and approval of plans. SIGNATURE OF APPLICANT PRINT NAME�QS / Y�.�CJI 1 DATE S `atol Z