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PRE 2010 DOCSA Village of Fridley, Minn. . BUILDING PERMIT ° 1815 , R fate: .. -..Q ...................... . Owner....................................... Builder .... %�.............. ..... Address...................................... Address ............................................. LOCAT ON OF BUILDING No ..... ... ..... Street .....s 7 /..................... Part of Lot .......... ....... Lot .....%....... Block ..... &� ........... Addition or Sub -Division . cP�.. ..... Corner Lot ........... Inside Lot ........... Setback . N.�..... Sideyard ..... .................... DESCRIPTION OF BUILDING To be used as: 0 ..... ..... Front .. 0 .. Depth 2-.`x!..3: ` Height . �7 .. Sq. Ft. ........ Cu. Ft. ........ ..................... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ........ Type of Construction .7 ..... Est. Cost ... J 3 ®.® ...... To be Completed .................. In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the village of Fridley. ..................................................... o�',7 In consideration of the payment of a fee of $ XZ ...... , permit is hereby granted to ool ......................... 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, a tdration, maintenance, repair and moving of buildings with- in the village limits and this permit may be revge` at any time upon violation of any of the provisions of said ordinances. a ... ....... `�... Building Inspector NOTICE: This permit does 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. City of Fridley, Minn. BUILDING PERMIT /N-((j:8:4�) Date: r 0 Owner: ..._X— ! . t A. tBuilder Address __:t ` . , Address _....�..__J► �..._ _ __.._. __ ._ CATION OF BUILDING F i No.Street _ -_.. __1 .p. i �r-.--------____ Part Lot ..__.. _._ PY h Lot .............If ................ Block .._... _................. ............ Addition or Sub -Division ... =._� j Corner Lot ...__........._..._..._........ Inside Lot . . Sideyard ....._...F.....�.----....._. _. Sewer Elevation ............................................ _............... ........ _.... ............... Foundation Elevation DESCRIPTION OF BUILDING To be Used as, _ -= p d g �..._.. Sq. Ft.._ „ CM Ft. Front __' Depth Height ✓. ._ ,.... Front -fid!" ' ....._.. Depth ...... moi._.. Height ..._..1._.. 'Sq. Ft. .f.�-.. Cu. Ft.1.0�'..Y_ Type o Cons tion .. r �?!� .:' .1.... Est. Cost....''...... To be Completed ..... ......... __.............. ............. ;S a: 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. r _. In consideration of the payment of a fee of $... ......_._...___...., permit is hereby granted to...._.._.._ ....... ..................... _... .... _ to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violatiog of any of the provisions of said ordinances. -­ A is 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. APPLICATION FOR BUILDING PEOM CITY OF FRIDLEY, TA . e Owners Name j der Address LOCATION OF BUILDING Of No. Old Street d Pert of Lot Lot ... Block. Addition or Sub.Div. Corner Lot Inside Lot /Set Back_ Side -Yard _(,_- SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To used as: �r�ont Depth Height t. Cu. Ft. G� Front % `� Depth / Height lop - Sq. Ft. Cu. Ft. 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 representa- tions stated in this application are true and correct. / e DATA �� �'® SIGNATURE (A Schedule of Fee costs can be found on the Reverse Side.) • City of Fridley, Minn.. BUILDING PERMIT Date: June 23, 1965 Owner: Edward A. Mareiniak Adams 601. 58th Ave. N. E. Builder Edward A. Narciniak Address 601 58th Ave. N. E. N? 8013 LOCATION OF BUILDING No. 601 sit 58th Ave. N. E. Part of Lot Lot 9 _ Block $ Addition or Sub -Division Oorumays Lakeview, Nanor Corner Lot Inside Lot Setback Sideyard Sewer Elevation Foundation Elevation To be Used as: DESCRIPTION OF BUILDING Front — Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Est. Cost _ 100.00 To be Completed • Storm damage repair n L_J In consideration of the issuance to me of a permit to construct the building des bed above I agree to do the proposed work in accordance with the description above forth and in with ail provisions of ordinances oP the city of Fridley. In consideration of the payment of a fee of $ 10e90 -., permit is hereby granted&d A Marciniak to construct the building or addition as described above. This permit is grantedupon 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 ung location, alteration, maintenance, repair and moving of buildings withino he. city limits � this permit may be revoked at any time upon violation of any of the provisions of said Allen Jensen NOTICE Uh pan& don no emm the com rm doe, t aftila ae for cabin& phm&k& an 6uft & www or wdw. Be sun to me tho Bu MhM bWed r for npnata pare I- fer flaw keen. OWNER'S APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA ADDRESS_ ,5�®/' ,j 'J� ,ADDRESS LOCATION OF BUILDING of Lot LOT OCR 0 ADDITION OR SUBDIVISION Corner Lot`_Inside LOT �Setback Side-Yard— SEWER ELEVATION .QUNDATION.°ELEVATIOR 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 Depth Height Sq. Ft. Cu. Ft. Front Depth _Height Sq. Ft. Cu. Ft. ap C2 Type of Construction Estimated Cost n s To be completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of.Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. ' SIGNATURES G (Schedule of Fee Costs can be found on the Reverse Side). . 1;L SUBJECT P City of Fridley1 AT THE TOP OF THE TWINS gUILDING PERMIT('�636 WCOYNO• I `y------I COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. �� �� r *I 1 I NUMBER REV GATE PAGE Of APPROVED BY = CITY HALL FRIDLEY $$432 612-571-3450 910-F15 6/26/98 JOB ADDRESS 601 58 Avenue NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 8 1 Donnay's Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Edward/Joan Marciniak 601 68 Avenue NE 571-6803 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. JRS Construction 23555 Monroe St NE, East Bethel Mn 55005 434-2651 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20091085 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION j] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garge (35 Sq) Tear-off; Repairs per Bid Sheet 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF'WORK OR CONSTRUCTION ZONING SO. FT, CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 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 $8,455 $4.23 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 ST TE OR LOCAL LAW REGULATING CON- $149.75 Fire F $8.46 STRUCTION OR THE PERFORMA E OF CON TION. nn PLAN CHECK FEE TOTAL F E 6 ,Itg Licens 5.00 Y167.44 IGNATURE OF CONTRACTOR RAUTMORIZED AGENT IOATEI N P PE LIDATE T I$ YO PERMIT 41- X�70 i4l BLO INSP , I — — OaTE SIGNATURE OF OWNERIIF OWNER BUILDERI IDATEI NEW [ J Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 X01 BUILDING PERMIT APPLICATION ConstructionAddress: 0 1419C)e— Al Legal Description: Owner Name & Address: [p (4.) AALI r J()A,-.) X41' UoJ,'A K Tel. # Contractor: 'T ► P, Se C 0 N S i R C) C- "0 � MN LICENSE Address: 3-5 'f M OAfRa e Sil /U 1-7-- CA ST Or t f�� L os- 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 Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: �`�� % APPLICANT: a Tel. # CITY USE ONLY Permit Fee $ / Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ . �3 $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ �. V $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 $ 1 2' STIPULATIONS: - C BID SHEET FH95-06 'r. au#A joan�Mardnlsk 601 - 58th Ave NE Fridley. MN 55432 #571-6803 M t S, Cori S-xv� 77, U� C tractor ontractor's Signature S-2 KIT HEN (with dining area) over structural �- a. Redo flooring. Install new vinylsheet fgrade underlayment. Congoleum or equal. 515.00 sq yd material allowance. Owner's choice of and patternEdgig of floor shall be covered (confirm , material and finish with owner). Specify total sq yd S E, b. Install new countertop, laminated plastic over composition board, one-piece with square edge and backsplash. Formica or equal. Owner's choice of color. S-3 BATHROOMl. all and new fiberglass shower S 2 a. Redo rrshower and withalls. Remove tie and molded soap dish. Kohle�alequal. aWhite colors. Seal all joints. Damaged drywall around liner wall sumo shall be made ready for finishing.O -- 1 () b. Redo flooring. Refer to spec S-2 a. Reset stool with new wax seal. Specify total sq yd S-4 OTHER ROOMS USED FOR LIVING AND HALLS a. Paint ceilings of all rooms on 1st floor room, two bedrooms, bathroom, dining room and kitchen). ` (includes living I painter's finish of owner's choice of Clean surface, seal stained areas and repair damaged materials. Appy p color. Benjamin Moore or equal. 3 / � S-6 BUILDING EXTERIOR .1-� � a down to bare �, Haul away debris. Replace rotted boards. Speciry a. bing Tear off shingl son house and Sar separate board replacement cost per sqftnstal 'nEnsure proper ice and venting shield. r insulated att c area. Install new jars and if damaged, rusted or missing, metal valley flashing. Install new drip edge where rated Type 15 felt. Certa steed or installed. Ridge shallbe laid asphalt shingles laid over one lay P Reinstall gutters. _ ?/a .,,ABoston" style. Owner's choice of color. Specify roofing sq _ Option: Shingle over existing r roof. Existing r ng shall be made clean, sound, even and uniform _(9 prior to new shingling. Roo p S 2.(090 b. Cover entire save area g house and garage with Apply aerated ml9 baked enamel aterial to vented soffit prefinished aluminum. Alcoa or equal. ensure soffit venting that • Replace rotted and damaged boards. Apply is o en to attic area for unobstructed air flow. Owner's choice of color. "'W! Option: Replace wood siding on east side of house with vinyl. Alsidor eq lication. owner's choice barrier, Tyvek or equal. Rework items that interfere with the new siding app of color. S C. Cover entire trim area around windows and damaged boards. Owner's choi ce a baked drenamel prefinishe aluminum. Alcoa or equal. Replace rotted 5 Sb d. Install new storm/screen door (entry nd screoff en inse)rtsS hardwaolid re and locking device for complete , baked enamel prefinished aluminum, y. weatherstripping, self -storing storm Benada or equal. Owner's choice of color. S S� e. Install new storm/screen door (east entry off breezeway)• Refer y)Refer to spec S-6 d. S�f. Install new storm/screen door (west entry off breezewa S-7 HEATING AND PLUMBING S �� ;, a. Install new furnace, forced -air heating unit, natural gas, AGA or UL listed, Carrier or equal, that will maintain a supply of safe and adequate heat to each conditioned room in the dwelling. The installed unit shall be _. sta designed to meet or exceed Reconnect tolnstallation shall existing plenumlanlude combustion air d distribution system tConnect t gasake and new linewith Vent to an approved flue. Reconnect proper shut-off. Haul away old unit. S b. Abandon well per State requirements.IV c. Install back flow preventers to laundry and exterior faucets. d. Vent wet bar in basement. A . r Install metal dryer vent , duct to exterior with screen and rainhood. �./hepp PAS � me*�G �VeN! y s ,ward and Joan Marciniak, 601 - 58t. 4e NE, Fridley Page 2 of 2 0 f. Install new water heater, 40 gallon, energy saver, natural gas. AGA or UL listed. Connect to gas and water I piping. Vent to an approved flue. Rheem or equal. Haul away old unit. S 9. Install new shower/tub fixture, chrome, anti -scald (thermostatic or pressure -balancing type) and with 3 gpm showerhead. Delta Monitor or equal. S-8; HEALTH AND SAFETY S a. Install fire door between garage and breezeway. New door shall be steel insulated (no window) prehung unit with threshold, weatherstripping, hardware, locking device and self closer. $200 door allowance. Castlegate or equal. Apply painter's finish to primed wood. b. Insulate accessible rim joist area in utility room with UL listed fiberglas batt insulation, R-19. friction fit. Seal all cracks and thermo by-passes prior to insulation work. Install drywall to insulated wall in laundry room. S )00 c. Install battery operated smoke detectors in working order, UL listed, in each bedroom.._ Sy 0 d. Paint garage overhead door and north window. Remove loose paint, clean surface, prime bare spots and !45� stained areas. Apply painter's finish of owner's choice of color. Benjamin Moore or equal. 5 ! e. Check attic insulation, if insulation value is less than R30, than submit bid to insulate attic to meet R-38. Seal all thermo by-passes prior to insulation work. Install air chutes where missing for soffit venting. Ensure proper ii venting for insulated area. 5 ! f. Replace cracked window panes with new. Confirm locations with owner. Speci4l total # of replacements S-9 ELECTRICAL S i a. Protect wall receptacles within 6'0" of kitchen sink with GFI. Install 20 amp wall receptacle at counter top. S b. Install wall receptacle in bathroom, protected with GFI. Disconnect or ground wall receptacle on light fixture. c. Ground wall receptacles through out home. Sd. Install smoke detector on each floor mount on ceiling in hallway between bedrooms and in basement on ceiling at base of steps. Interconnect and install battery back-up. Reuse existing hardwired smoke detectors if possible. Wire furnace on separate circuit. fi�•o, s �s on 0 c.rcw:� S f. Protect wall receptacle by wet bar sink with GFI. Install wa I receptacle by basement wall hung sink, protected by GFI. Doss ru, 'U� 5 1 � � TOTAL BID BID GOOD FOR 90 DAYS FROM This work write-up describes the rehabilitation work to be performed on the subject property. The contractor will be required_ to do all work in a trades like manner and in accordance with the building code and TECHNICAL SPECIFICATIONS. ALTERNATES: S 1. Code plumbing system. Specify all other plumbing code work not listed above and the cost per work item. S 2. Code electrical service. Specify all other electrical code work not listed above and the cost per work item. o w tc�a�►a°t� , WELL OR BORING LOCATION MINN OTA DEPARTMENT OF HEALTH Minnesota Well and Boring Sealing WELL AND BORING SEALING RECORD Minnesol.3 Unique No. H 144863 �] a J County Name Anoka Minnesota Statutes, Chapter 1031 or W -series No. (Leave biw* d not knarn) Township Name Township No. Range No. Section No. Fraction (sm. i Ig.) Date Sealed Date Well or Boring Consinrcted Fridley. 1 34 I 24 23 IG N w 10-2-98 Numerical Street Address or Fire Number and Cityof Well or Boring Location 601 58th Ave NE, i- r I d l ey Depth Before Sealing 43 ft- Original Depth „. Show exact location of well or boring Sketch map of well or boring AOUIFER(S) STATIC WATER LEVEL in section grid with X.. location, showing property lines, roads, and buildings. N �Y- -T- �Y� -1-� ' ' XSingle Aquifer [IMultiaquifer Measured [I Estimated 3 fte>aw ❑above lard surface WELL/BORING ® Water Supply Well ❑ Monit. Well ❑ Env. Bore Hole ❑ Other CASING TYPE(S) W -T- 4- �1-- -4- E -r- ---- -i-- --i-- { `-,, I a m�e tAR --; - t-1 -i-- -I- ® steel ❑ Plastic ❑ Tile ❑ Other CASING Diameter Depth Set in oversize Isle? Annuatm Yg e ar spaur6ay atd! S `G— I Mile2 in. from 5 to 39 fL 11Yes. UNo ❑ Yes ❑ No ❑ Udanwn I in. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ UNmowr in. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Urftio m PROPERTY OWNER'S NAME JRS Construction Property owner's mailing address i1 different than well location address indicated above. fi�ee,�,, ppe�r ��J�� Monroe Jt NE �. East Bethel, MN 55005 -SCREEWOPEN HOLE Screen from 39 to 43 IL Open Hole from to R OBSTRUCTIONS Rotis/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ FID ❑ No Oar WELL OWNER'S NAME 151 119 d.p. & jet Type of Obstructions (Describe) Wit We miffing address it afferent than Property owner's address indicated above. Obstructions removed? 14Yes ❑ No Describe PUMP ,,•• Type OW Jet R Removed ❑ Not Present ❑ Other GEOLOGICAL MATERIAL I COLOR HARDNESS OF FROM TO FORMATION If not known, h.11— est6rmted formation tog from nearby well or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE No Annular Space E)dts ❑ Annular spam grouted with hands pipe ❑ Casing Pedorabon/Removal In. from to fL ❑ Perforated ❑ Ranoued In. from to fL ❑ Pedoreted ❑ RamoYed Type of perforator ❑ Other GROUTING MATERIAL(S) fit Cmt 5 43 1 Grouting Materiel from to If. yards bels from to /L yards bad from to 1L yards bays from to R yards bels REMARKS, SOURCE OF DATA, DWRCULT14S IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boiling on property? ❑ Yes No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or bo" was sealed in accordance with Minnesota Rules. Chapter 4725. The irlfarrnatien aarrtskred in tis report is true to the best of my knowledge. Awzl%well Oo., Inc. 42ii58 or Fla I 1 0 M � � ✓✓ 1Q-5-98 Autlror&sol Awresentatim $romaine Dab Tim C$ oui nar d - LWAL COPY H 144863 ftm of Pe>sm salt" Wall or Ba ll HE -0143403 aw R CITY OF FRIDLEY INSPECTION DIVISION 6431 University Ave NE Fridley, MN 55432 572-3604 RATE SCHEDULE Residential APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Rate TOTAL $ 30.00 $ J $10.00 $ $10.00 $ $10.00 $ $ 25.00 $ State Surcharge TOTAL FEE $ .50 "70 MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION' REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr 1 Effective On January 1; 1998 JOB ADDRESS ADO J 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. /O c ,1998 OWNER6:01WA/ZC_/Ai fl%` BUILDING USED ASPc6SI0RU 7-If1Z-- 11, ESTIMATEDCOST 12-00 PERMIT NO. /331`7 DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (St Trade Name &V--AAJ/6L— BTU 7S;Ooo HP am) (Hot Water) arm Air) Size No. EDR Fuel m ,�T G AS Total Connected Load I OQ, CX)(- Burner Trade Name 49 Size No. BTU HP EDR HEATING COMPANY tV,9 fZD �&PF/N� Signed By Approved E Tel No. 753 -1f5 Rough -In Date Final Date" *Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE OR STACK VERIRcATION ON written permission from adjoining property owner. REPLACEMENT FURNACE CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: Yes (.4 No ( ) 1. Has been carefully examined 2. Is free from rust or deterioration 3. Has no foreign objects lodged within 4. Is securely supported 5. Meets all current Code requirements for size and total BTU's connected 6 Has total heating BTU's of 1e �0 d All other BTU's TOTAL BTU's /OS7- ,000 Yes No ( ) Yes ( No ( ) Yes No ( ) Yes �) No ( ) 7. Has a liner been provided for water heater A✓l Yes ( ) No (7ilJ 8. Has combustion air been provided for water heater Yes (WNo ( ) Remarks: . List ALTERATIONS Being Done: HEATING CO: Signed By: Date: CITY OF FRIDLEY INSPECTION DIVISION M ti )5 t_oq 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572-3604 , REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE 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 *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Effecti�on�Janua ®, 2 2 JOB ADDRESS' l V - 5S� 1'�t�uwe 1QC� OWNER r d t <�r v� I l�Yl✓iiil�A�i� Rate TOTAL BUILDING USED AS $ 30.00 $ I ESTIMATED COST PERMIT N0. $ 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 Size No. BTU HP EDR $ 25.00 $_C25D® 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. 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 $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE), -_-2 DEPENDABLE INDOOR AIR QUALITY. INC. HEATING 0 _61gCOQN RAPIDS BOULEVARD Signe G00 DS,�MN 433 # ®1Gaa2) ?57 FAX # -7 QO'E5 -3 57 5) �1 Dc Approved By Rough -In Date Final Date®'�- THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED COMMON VFNT- VENT CONNECTOR AND COME3IISTION AIR VFRIFI CATION When re In acing an axicting f iri aom, 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 manufacturers specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes( ) No( ) The Pxisting cnmh ,s inn air is sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When required to install a new cnmbustinn air,itwill be sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When installing a new venting systeam, 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 #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 : / 6 2f • Z -r rYw✓p � Building BUILDING Permit No.: - 0 Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: !� a DATE — I p YOUR E-MAIL ADDRESS sITE ADDREss 40/ / 5—,P /WC /U C - THIS APPLICANT IS: ❑ OWNER XONTRACTOR PROPERTY OWNER/ NAME: AtLI -e/a o .''e.S ADDRESS: �®/ 9rA `P' �-7OC N� CITY i ✓l/ STATE��ZIPy32 TENANT PHONE: & 1 Z 2-9/ g®2O CONTRACTOR NAME: TWIN SUBMIT A COPY OF STATE LICENSE # TE YOUR STATE LICENSE ADDRESS: Was CITY STATE ZIP WITH APPLICATION PHONE PROPERTY TYPE INGLE FAMILY/NEW CON SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED 431WNMWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ ADDITION ANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF RAPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: Plan GARAGES ❑ ATTACHED GARAGE 2. ProposedFloor 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 )PENINGS�f� ,Q W�� IN FOR 3. Energy Calculations OR NEW OPENINGS -'DESCRIBE SIZE OFi0� OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED 09 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 $ W DO OCCUPANCY TYPE Permit Fee Plan Review Surcharge Fire Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge $ �7•Z� $ $ 6 S See Back Page for Fee Schedule 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 Davable 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 tl,ch,,re'�q''uire evie and approval of plans. (� I - SIGNATURE OF APPLICANTk�V �CJt-l. lAl� PRINT NAM B �I 1Q Y I L YO W n DATE J.