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PRE 2010 DOCSBUILDING PERMIT Village of Fridley, Minn. N? 2294 G Date............................... Builder ... 1/ ! Owner .. 'G1.. ..... Address ..`•fs� . �1''�':'..��. Address s. �?I LOCATION OF BUILDING No. ....�.� �' Street .................. Part of Lot ....................... i Lot . . t . !. Block .......... � • % ... Addition or Sub -Division .. l.;7r/ �' , Corner Lot ........ !1... Inside Lot ...A ...... Setback Sideyard � +! ! �.'' ............ . I To be Used as: ...�..., i ...................�, Type of In considemtic the proposed work ordinances of the i the express condition done in, around and Fridley, Minnesota i In the village limits ordinances. DESCRIPTION OF BUILDING Front .W?... Depth J f'n Height /. !'5 �... Sq. Ft......... Cu. Ft........ . Front ... .. Depth ........ Height ......... Sq. Ft......... Cu. Ft........ . ."?� Est. Cost . /.�.. �... ..... To be Completed 4.0*.......... of the issuance to me of a permit to construct the building described above, I agree to do accordance with the description above set forth and in compliance with all provisions of age of Fridley. if the payment of a fee of permit is hereby granted to`... .... .. to construct the . building or addition as described above. This permit s granted upon that the person to whom it is granted and his agents, employees and workmen, in all work ipon said building, or any part thereof, shall conform in all respects to the ordinances of garding location, construction, alteration, maintenance, repair and moving of buildings with- nd this permit may be revoked' at any time upol viglekon of any of the provisions of said :... ":.. `.'.':...... Building Inspector NOTICE: This permit �oes not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see -the Building Inspector for separate permits for these Items. 4-4 , Y.. City of Fridley, Minn. BUILDING PERMIT N° 6 z Date: Omer: , ire- °�-: fA10,.jJW ' rp Builder Adf-m7-s Address LOCATIO BUILDING No. StreetA A.�Z€ z'r"" Part ofLot Lot_Block Addition or Sub -D vis Corner Lot — Inside Lot. _ ".f%Mback Y ^ ide 'f Sewer Elevation ____ rolloCion Elevation DESCRIPTION OF BUILDING To 01 aak:if Front Depth Height o" Sq. Ft. ? Cu. Ft Fro Depth eight Sq. F't cu. Ft Type of Constructs EstTo 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 ordinances 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 Pe 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, re and moving of buildings within the city limits and this permit may be revoked at any time uponolati�any of the provisions of said ,.... — -- NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to we the Building [Wector for separate permits for these items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owner's Name der Address Address LOCATION OF BUILDING I Addition Inside rt of Lot vision 2Side-Yard; + � ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To b:ct Front Sq. Ft. 0 Front Depth Height Sq. Ft. Cu. Ft.` el CJ Type of Construction 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 correct. ,f/A DATE K �' � � Lei f SIGNAT� (A Schedule of Fee Costs can be found on the Reverse Side.) MIM 214 SUBJECT P E City of Fridley o 13694 AT THE TOP OF THE TWINS BUILDING PERMIT r ECEIPT N COMMUNITY DEVELOPMENT DIV. r � PROTECTIVE INSPECTION SEC. �/ � -'i CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 812-560-3450 910-F15 8/10/76 JOB ADDRESS 525-53�s Avenue N.E.-II 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 14 1 Temple Terrace SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE B. Duchscherer 525-53'1 Avenue 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 X 8 DESCRIBE WORK Construct a 22' x 13' Porch Addition UN &AM P 9 CHANGE OF USE FROM TO STIPULATIONS p ;P&j) f ,04C n t:: t c t ;,-f a a1 IgIF QD® F/.IAC.- M,4746/ 4 C S BE "PIC *-05? "-4M& Com ZO-C n OrJ 6E SEPERATE PERMITS REQUIRED FOR WIRING, HEATING,. PLUMBING AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood/Screen 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 R-1 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING '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. $750.00 .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- $7.50 STRUCT N O HE PERFORMANCE OF CONSTRUCTION. ' PLAN CHECK FEE TOTAL FEE 1LI( $8.00 SIG AT RE OF CONTRACTOR OR AUTHORIZED AGENT)ATE) W N PROPEJRJtY LI ATED THIS IS YOUR PERMIT BLDG INSP DOTE - SIGNATURE OF OWNER IIF OWNER BUILDERI (DATE) CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL ALTERATION, ADDITION, OR REPAIR BUILDING PERMIT OWNER'S NAME: 14 / z S C I[ e -C e 1-' BUILDER: S f I � ADDRESS •,,2 ,5-- 5-3 ala ADDRESS: e NO:. STREET : , /�} 15)d .-f- / ' ', LOT: BLOCK: % ADDITION: 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. DESCRIPTION OF BUILDING To Be Used As: I L�®Front: o�� Depth: 1-3_ Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: U)ood -4-TCre a vc Estimated Cost: To Be Completed: W E � Ks, 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 and correct. DATE: W-10 ^ :2 .- SIGNATURE: (See Reverse Side For Additional Information.) i r� ELK RIVER CONCRETE PRODUCTS • 8609 LYNDALE AVE., SO. * BLOOMINGTON, MINN, 55420 (612) 884-7362 • INWARD WATS - 800 + 552-1158 ELK RIVER CONCRETE PRODUCTS • 8609 LYNDALE AVE., SO. o BLOOMINGTON, MINN. 55420 (612) 884-7362 • INWARD WATS 800 + 552-1158 SUBJECT PE NO. City of Fridley _ _ 1.61.9 AT THE TOP OF THE TWINS BUILDING PERMIT COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC.hod � I CITY HALL FRIDLEY 55432 I.' NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 5/21/81 JOB ADDRESS 525 - 533i Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 14 1 Temple Terrace SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Barney Duchscherer 525 - 53�i Avenue N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Salitros Roofing & Siding 1106 - 50th -Avenue N.E. 571-9569 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 X 8 DESCRIBE WORK Reroof Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS Roof can be 2nd but not 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 SQ. 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 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 $1200 $.6O 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- $9.00 STRUCTION OR THE PERFORM NCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $9.60 I NATURE OF COI; RA TOR OR AUTHORIZED AGENT (DATE) WHENPROPERLY VALIDATED THIS IS YOUR PERMIT .'Ls BLDG IN SP DAT SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) CITY OF (=RIDLEY APPLICA'(IO'J FOR RESID[:itlTI/li_ BUILDING PEfJ4ITS (New, Alterations, /additions, or Repairs) OWNER: ej.U�LC_.L�C��y`��a ADDRESS: Nva? At. E TEL NO: STREET .NO: STREET: BUILDER.�� ADDRESS: �(� — { ��• �e TEL 110: 2�-2(� Construction Location LOT: 14 BLOCK: �� ADDITION: -a -.6-112_\e- :1 �2= ` ems_ 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 Front: Depth: Height: Square.Feet: Cubic Feet: Front: Depth: Height: Square - Feet: Cubic Feet: Type of Construction: Pj4d ((— Estimated Cost: $ l abo , ®c-_> xb Be (bmpleted: Proposed Driveway Width If New Opening Is Desired: Alt. A Alt. R SEE REVERSE SIDE OF SHEET Mie undersigned hereby makes application for a permit for the work, herein specified, agreeing to c=o,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 and correct. MNTE : % a SIGNATURE: Stipulations I SUBJECT P City of Fridley 1912 5 AT THE TOP OF THE TWINS BUILDING PERMIT GEIPT NO. Jr � • COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 � � i '•',,� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY ---- L , ` 612-571-3450 910-F15 8/20/87 JOB ADDRESS 525 - 53 1/2 Avenue N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 14 1 Temple Terrace 2nd. Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bill Taylor same 571-4423 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. D,& D Home Improvement 7401 Central Avenue N.E. Fridl MN 55432 784-7543 , 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 [k ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Siding, Trim Windows Roof Garage 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 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $7,900.00 $4.11 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $68.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �j PLAN CHECK FEE TOTAL FEE $72.61 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEi WHEN PROPERrIAL BLDG iNSP ATED IS Is PEM C//✓fC/DATE SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI NEW [ ] City of Fridley Effective 4/1/86 ADDN. [ ] R-1 AND R-2 ALTER. [ ] Building Permit Application Construction Address: S :5:3j� �� 4/4�- Legal Description: LL+ yy �� 25Wa Tel. # Owner Name &Address: L 0 /� e/�/�/�'l�erne�r 7` �'?�C P Tel . # Contractor: Address: ��0� Cell*" l F-R)"d/e ( 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: DECK AREA: OTHER: DESCRIPTION OF IMPROVEMENT Width Length Width Length Width Height Height Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. Corner Lot [ ] Inside Lot [j(1 Ft. Yd. Setback Side Yard Setback �g e Type of Construction: 5'�`n�� `�r `ilillciawsi loo-foyk Estimated Cost: $ Approx. Completion Date: 47-3 D Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: -5-30-917 0-917 APPLICANT: E1211- 0/50 /1/ Tel. # 7.g4l- - �.3 Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $ 525 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] 7. SUBJE& MIT NO. City of Fridley 29934 AT THE TOP OF THE TWINS BUILDING PERMIT r O. COMMUNITY DEVELOPMENT DIV. INSPECTION SEC , /� moi/ PROTECTIVE �,; CITY HALL FRIDLEY 55432 NUMBER pEv DATE PAGE Oc APPROVED 8r L 612-571-3450 91aFl5 7/26/99 JOB ADDRESS 525 53 1/2 Avenue NE 1 LEGAL LOT NO. BLOCKTRACT OR ADDITION SEE ATTACHED DESCR. 14 1 Temple Terrace 2nd SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP.,..- PHONE Kevin Cleberg m y. 571-4232 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Sela Roofing & Rem. Inc. 4100 Excelsior Blvd, - 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 9k REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house, garage and back porch 28 S Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REOUIREO 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2447 $1.22 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 $83,25 FireAC $2.45 PLAN CHECK FEE TOTA F E Lice C 5. .92 SIGNATURE OfLDN'RACTOR OR AUTHORIZED AGENT IDATEI EN OALIDAT Hy$ L5.,tOUR PERMIT $,GN4 TUAE OF Qyy NEpiIF OWNER BUILDER. IDATEI BL INS MATE NEW [ l ADDN I l ALTER [ ] ConstructionAddress: Legal Description: Effective 1 / 1 /99 CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION „(A� /Vy Owner Name & Address: keel n le -,e Tel. # 61z 5-7( - `/- 3,2-- Contractor: oZContractor: S -8-A ROWNG & aFmnnEl two INC. MN LICENSE # J So Address: 41oo EXCELSIOR BLVD. Tel. # 3 AttacIPplication, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF BIPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. �@Ifs , Construction Type: f&ARVFF ACAool t10 L -5e Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: `7',? 6'- �I�1 APPLICANT: Tel. # TOTAL $ �. STIPULATIONS: CITY USE ONLY Permit Fee $ o2y Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th o) State Surcharge $ , .2 $.501$1,000 Valuation SAC Charge $ $1050 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 $ �. STIPULATIONS: v' NEWS [ ] CITY OF FRIDLEY ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Legal Description: (763) Bldg Insp Owner Name & Address: Tel. #76n 71-- elZ "3 oa#raCl6P�- MN LICENSE # Address:' S2'S S _5 ii ANA -A? C 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 i a.� Width '70,57 Height Y � Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: -S+F- e Rsc4b f 0 Made ) Estimated Cost: $ Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ =$ DATE: '9/7/05 APPLICANT:_ 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. Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1450 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 [ ] STIPULATIONS: cwN\rN -e 0 sa�_yc"utes4 -fa Mph p4xo `,c -,* C- 1� a yes 3(-7. (.1. e •� r pe p lv✓u t-,); i-v, A 6 s lP p e s oovvt +,, ►,1 5 4c) Iocc4� rn ac�--I-hCf m-e4 UAV-,O Cl (:3 G -P ��a W OAA uj ,e Y�i rtC I-tJ CLU p yo t (n z amend r1w► e o �� uj L�j 5 pi CL CJL ptc 4j,-o- LO dxl� 13 Yl\ 54CL-1 I L V? 4�- Y-v n e"PA eA- l�' 5 )um jut 10 / "1Tn.v►dfel Wi4N R1J 2GGFSSG�� IUS�w CAU CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT UADIC NI IMRFR nF FI)M IPPS T(7j RF INSTAI I Fn nN FA(.H FI 0014 01 Stones I.�S::: Un Urinal111101111111 Shower :::: � � <::<:::::: :F�.�.t........ Wash I ::::>::: ;Floor Tray �' :.' :.•�:;::::::: Dram ...?k?�. ::> ::Auto. sft'f<��: :.........:. ::::::•::::: G8S Washer ,� ...>::::::::: Ran a :::<::> Water Heater ...:::.::::: :.: ... �� >.::::: Gas Elec Base . .< �< $10.00 //�� 5 QJLP-VBP $35.00 OWNER �.C9 %V'_lit $35.00 I r1 F o0 i BUILDING USED AS �?c : esu S A $10.00 $10.00 ESTIMATED COST PERMIT NO. Floor 2 Floor 3 ,Floor ` PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS S 2S 5 312 AYA, N New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin 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 The undersigned hereby makes application for a permit for the work herein $10.00 specified agreeing to do all work in strict accordance with the city codes $10.00 and rulings of the Building Division, and hereby declares that all the facts $10.00 and representations stated in this application are true and correct. $10.00 $10.00 DATE: ZQ-!5 , 20 a S $10.00 //�� 5 QJLP-VBP $35.00 OWNER �.C9 %V'_lit $35.00 $35.00 BUILDING USED AS �?c : esu S A $10.00 $10.00 ESTIMATED COST PERMIT NO. $15.00 Reinspection Fee $50.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge $ .50 TOTAL FEE $-10--.50 PLUMBING COMPANY SIGNED BYcakTEL N0. 7(63-S 7 i'4Z3 Z Approved By Rough -In Date Final Date 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 k 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 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 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 air, it 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 Fumace 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 MECHANICAL Permit No.: —67, RESIDENTIAL APPLICATION Received By: A' Vk V 763-572-3604 CITY OF FRIDLEY D , 'h1DV 3 0 2009 763-502-4977 FAX EFFECTIVE 2-19-09 1 DATE ) c o Q YOUR E-MAIL ADDRESS C 1 SITE ADDRESS 1 i )) .3 _\ - `I 7? -- THIS APPLICANT IS: ,H OWNER OCONTRACTOR PROPERTY NAME: �+ ,.�, 'tiC Q Lo OWNER/ ADDRESS: SrkAaA ¢r4� cb®_ CITY STATE ZIP TENANT ., --� PHONE: CONTRACTOR COMPANY NAME: CONTACT PERSON: SUBMIT A COPY OF YOUR STATE STATE LICENSE # EXP DATE LICENSE WITH ADDRESS: CITY STATE ZIP APPLICATION PHONE FAX 17 TWO FAMILY 0 TOWNHOUSE PERMIT TYPE SINGLE FAMILY TYPE OF WORK: ❑ NEW PPL�AC�,E,�MENT ❑ ALTERATION/REMODEL �rT l DETAILED DESCRIPTION OF WORK 1 Y 1 1 V VU, QA 5 V !�A� FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED:1 FI1tTURES: (INDICATE TOTAL NUMBER OF EACH -BELOW) PROVIDE HEAT LOSS CALCIS PER MANUAL J 2006 ASHRALHANDBOOK.: 1 1, .. '_� -; .: -..:.. Equipment Installed MFG: MODEL: SIZEBTU MFG: MODEL: SIZEIBTU MFG: MODEL:/ SIZE/BTUA/C /GAS $25.00 (GAS) $15.00 RANGEIOVEN $10.00 _FIREPLACE _AIR TO AIR EXCHANGEER $15 (WOOD) $35.00 NEW GAS GRILL $10.00 _FIREPLACE _BOILER $35.00 _FURNACE $35.00 _GAS UNIT HTR $10.00 LINER $10.00 DRYER $10.00 _POOL HEATER $35.00 _CHIMNEY _GAS DUCT WORK $10.00 GAS PIPING $10.00 ' VENTILATOR $15.00 �.-s° 'a' '� %, _ 'N�';• � ��+a`u y QE •'� f� ^S '.'F iF "�'c�� - £ .�iJ ._.§'. S Y. .� �'.� 1S}'� s%.Mi-.f"4 k. y•a..3;� atea"7` �. N a{`�,� _ ?r € � a,..: a . =� � � �'' .3 � ,."` �fi � M '(.&, A^"�''v _& 3 f 1z� ��A � � �.� o .� F � � ��.`s.,•'. 1 ,��, � � •�- �7.�' fX� J�s�� '. Lu � � -. a. `�F"S �tE' v. �� k �", � £ S+rx h ? � }S�y ys� ''�4,tif4'"' >� � v„ S, .,�,-'fl'�3 �� a' 2 •��, .a�,�._'' _-^ �i p"r�A�k�iiv �^'�� g �� s'r '� '��, F�� '�,`' �d '�.4 � i& -� £ m'i+'�� ^4�+A � DLi57� �i , � r �kN ,�• � l: �'%'�' ?" 1 � � '�,& K £' ��'� - �� F � 9 � � i� $ A � ?. . ku, ems- - v � � -y':, �5. 4€.� --..cv.R� � � P �.• f. 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 111 uires review and approval of plans. ++ SIGNATURE OF APPLICANT o PRINT NAME JK 0 y \,,X A �DATE 1 d o APPROVAL INSPECTORS SIGNATURE DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 City of Fridley Residential Mechanical Application Page 2 REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMES/ADDITIONS 0 EXISTING HOME 0 MAKE-UP AIR REQUIRED FOR NEW/EXISTING HOMES 1. Combustion Air (See note below) a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments 2. Make-up Air (See note below) a. IMC Chapter 5 with MN Amendments MN Rule 1346 Sec. 501 3. Venting A. Gas appliances IFGC Chapter 5 with. MN Amendments _ b. Fuei other than gas IMC Chapter 8 with MN Amendments 4. Heat loss & cooling load per room a. MN Rule 1322, Sec. N1104.4.13 5. Ventilation a. Per MN Rule Chapter 1322. Sec. 1104 6. Duct Design Per IMC 1346.0603.2 a. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make-up air calculations. Building Inspections 763-572-3604 763-502-4977 FAX SITE ADDRESS THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE, BOND AND CERTIFICATE OF INSURANCE PLUMBING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 2-19-09 Permit No.: lbo i Received By: A� YOUR E-MAIL ADDRESS JCC ('L �aj/'G C C (A Si a n C 1 ,O'OWNER 13CONTRACTOR PHONE: -16, 1 5 114 �� Z STATE LICENSE STATE BOND # _F7" STATS rIkIP S5 LtZ/ EXP DATE EXP DATE ADDRESS: CITY PHONE PERMIT TYPE 1,0 SINGLE FAMILY 0 TWO FAMILY TYPE OF WORK: 113 NEW 12,REPLACEMENT DETAILED DESCRIPTION OF WORK FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. $35.50. _ BATH SINK/LAV DRAINS —BATHTUB _FLOOR GAS PIPING (NEED CITY LIC) CLOTHES WASHER= KITCHEN SINK L, -DISHWASHER LAUNDRY TRAY FAX ❑ TOWNHOUSE ATE ZIP FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE _ SHOWER ,—SWIMMING POOL _ WATER CLOSET _WATER HEATER ($35) WATER METER THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED _ WATER PIPING _ WATER SOFTNER ($35) _ BACKFLOW PREV. $1 FOR IRRIGATION OTHER I hereby apply for a plumbing 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 all c which requires review and approval of plans. SIGNATURE OF APPLICANT PRINT NAME Kk\k -,--,C-1 Q- �S DATE < (/36/09 City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977