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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N° Q5981) Date:4� - " �— t Owner: Builder Address Address ON I BU LDING No. i. ,Street t, ri►AqCA � -�� t P Lot ..+ .6' Block Addition or Sub -Division _ Corner Lot . _ Inside Lot Setback Sideyard Sewer Elevation _ Foundation Elevation DESCRIPTION OF BUILDING To Front Depth Height Sq. Ft. cu. uzfdo Fron Depth Height Sq. Ft. Cu. Ft. � � Type of Aocr of ZnZuctlon Est. Cost .1 0? --'Io 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 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 type u%n violation of any of the provisions of said ordinances. 1,�e Building Inspector NOTICE: This permit does not cover the construction, installation for wlrtng, plumbing, gas heating, sewer or water. Be sun to we the Building Inspector forseparate permits for them hens. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owner's Address LOCATION OF BUILDING No.r� �n �� Street . taj&22e , Part of Lot _ Lot Block �% Addition or SubdivisionZ.r Corner Lot Inside Lot Setback Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: Front�Depth / D / Height Sq. Ft. cue Ft. Depth P VP Reight Sq. Ft. E Cu. Ft. �oQo 6 Type of Construction l/ 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 of Fridley Ordinances and ruling of the Department of Build- ings, and hereby declares that all the, facts and representations stated in this application are true and correct. DATE L ,7) SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). 0 M s n 10.�IfAbfq SIZF, BLOCK Arm, ss- VALrAT-ON ,UD.ITYPE -A.. ...- • • • City of Fridley, Minn. BUILDING PERMIT Date: Oct. 11, 1968 Owner: Calvin Hagberg Builder Address 665 59th Ave. N. E. _ Adm Same Same LOCATION OF BUILDING No. 665 _Street 59th Ave. N. E. --- part of Lot Lot 5 Block 2 -- Addition or Sub -Division .,_..ponnav _ Corner Lot — Inside Lot Setback _ _ _ _ Sideyard Sewer Elevation --- Foundation Elevation N9 q��5 9980 DESCRIPTION OF BUILDING To be Used as: Alterations Front _ Depth Height _ Sq. Ft. Cu. Ft. Front Depth Height _ _ Sq. Ft. Cu. Ft. Type of Construction ` FrameEst.Cost __15 00.00 _ 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 case liance with all provisions of ordinances of the city of Fridley. /1 P 't ',JJ � in consideration of the payment of a fee of $ 5 .00 , permit is hereby granted to Calvin Haeberg 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 an 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 buil within the city limits and this permit may be revoked at any time upon violation of any of the provisions of d ordinances. C arence Belisle NOTICE: This permit does not cover the construction, hwtailation for wiring, plumbing, gse heating, sewer or water. Be run to too the Building Inspector for separate permits for these home. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNEE oS NAME Ceu vx" %' �� BUILDER ADDRESS_ �� 7_7t Il-C� {/�// ADDRESS LOCATION OF BUILDING NO. 5- STREET 4- k --e. LOT ®BLOCK ADDITION OR SUBDIVISION COR -1\M LOT INSIDE LOT SETBACK SIDEY.ARD SEWER ELEVATION TOP OF FOOTING Applicant attach to this form Two Certificates of Survey of Lot and proposed build] -r -g location dram on theso Certificates To Be Used As: DESCRIPTION OF BUILDING Front f Depth Z Height Square feet Front Cubic Feet Depth Height Square feet Cubic Feet Type of Construction 117 Estimated Cost : Q 0 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 axe true and correct. DATE i �� SIGNATURE w (Schedule of Fee Costs can be found on SUBJECT ERMIT N City of Fridley O 1690c AT THE TOP OF THE TWINS BUILDING PERMIT rp R • __ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. V91r 1 . � l---.--;,j CITY HALL FRIDLEY 55432 NUMBERREV. DATE PAGE OF APPROVED BY L „ 612-571-3450 910-F15 4/Z9/83 / / JOB ADDRESS 665 - 59th Ave. N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. r, 2 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Calvin Ha ber 665-5 3 CONTRACTOR MAIL ADDRESS P O L CENSE NO. Owner 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 6 DESCRIBE WORK Reroof 9 CHANGE OF USE FROM TO STIPULATIONS Roof can be second but not third. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Asphalt ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN BO 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 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 $1,500.00 $.75 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE -WHEN $25.75 SIGNATURE OF CONTRAC RAUTHORI DAGENT IDATEI PRO ERL� LID ED THIS IS YOUR PERMIT SIG AT OFO NERIIF0 NERB RI ID TEI BLDG INSP OATE CITY OF FRIDLEY Effective Aug. 1, 1961 APPLICATIM FOit RESIDENTIAL BUILDVIG PERMITS (New. Alterations. Additioni. or Repairs) OWNER: 1�411U& 11A ADDRESS:. ��g _"J4V.0 TEL NO: 5- BUILDER: _ JTA%IT 'E ADDRESS: TEL NO: Construction Location • STRIST NO s STJtEET: OZ& A .,o^ / LOT: S BLOM t 4a I ADDITION: d✓tilY�1/,9�/�.S Corner Lot: Inside Lots --� Setback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. -� DESCRIPTIOR OF MNSTRUCTION -C- �P��_ Front: Square Feets Front: Depth: Height: Cubic Feet: Depth: Height: Square Feet: Cubic Feet: p4tl p't-r Type of Construction s 8�� 7b Be Cbr-pleted: -A 7973 Estimated Cost: Alt. A Alt. B Proposed Driveway 'Width If New Opening Is Desired: SEE REVERSE SIDE OF SHEET The undersigned hereby mates application for a permit for the work herein specified, agreeing to do•all work Ln strict accordance With the City of Fridley Ordinances and rulings of the Dclx-ix ncnt of Buildings, and hereby declares that all the facts and representat ens stated in this applic� DATE: a fASIGNATURE: Stipulations: SUBJECT PERMIT NO. City of Fridley 2 618 AT THE TOP OF THE TWINS BUILDING PERMIT ` RECEIPT NO. ►v _ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r � 1 � � NUMBER REV DATEPAGE OF APPROVED BY CITY HALL FRIDLEY 55432 j 612-571-3450 910-F15 6/9/98 JOB ADDRESS 665 59 Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 2 1 Donnay's Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Calvin Hagberg 665 59 Avenue NE 571-6874 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Midwest Siding & Roofing 18979 Gladstone Blvd, Maple Grove, MN 55311 416-4804 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20010277 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK a ❑ NEW ❑ ADDITION ❑ ALTERATION X REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK R.eroof House & Garage (31 S) Tear -off 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 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 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 $2,585 $1.29 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 - $87.25 Fire SC $2.58 CT N OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL �U Licen1-"'!5.00//$9/7-12 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI NPR P LIDATED SIS VO R PERMIT '000 BLDG 1 SP • s r�AiE SIGNATURE OF OWNEROF OWNER BUILDER) iDATEI NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 -f BUILDING PERMIT APPLICATION bigi ConstructionAddress: && -S Legal Description: Owner Name & Address: Cc? &/A -s lj elr-� Tel. # b �7 y Contractor: A1 ; 04ce- w, G MN LICENSE # �Peeyod 72 Address:sS-311 Tel. # V""& - /,eoy Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF E%IPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: 31 -S p Construction Type: 7ecr-o F -C, At, sc t (xic y t Estimated Cost: $ S G 9 O /0 (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 6 . 51- 1�9 APPLICANT: 1�'�� /�/� Ss Tel. # TOTAL $ 16, /Z - STIPULATIONS: CITY USE ONLY Permit Fee $ , Fee Schedule on Reverse Side Fire Surcharge $ .9, .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 $ 16, /Z - STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 763-572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On Jan 1, 2001 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 6 i�5 S 5 A kl) d VC fir,'U' /e D 0 New Fixtures $ 7.00 � The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $ 7.00 and representations stated in this application are true and correct. Catch Basin $ 7.00 Rain Water Leader $ 7.00 �� . , 209/ Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Owner Water Heater -Electric $ 7.00 Water Heater - Gas** $10.00 ,� Building Used As / 1GSec/61 t' a Gas Range*" Gas Dryer** $10.00 $10.00 / y Estimated Cost PERMIT NO. /,. Back Flow Preventer Required ( )Yes () No Type $15.00 !� PLUMBING COMPANY O/ -S /� 9(f_5_5 IC . Reinspection Fee $47.00/Hr SIGNED BY TEL N0: x.53 -233 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance Approved ByRough-In Date Final Date �d J� " 4FR State Surcharge $ .0o50 TOTAL FEE $ ��O -S?-) MINIMUM FEE ANY PLUMBING/GAS PERMI[T IS $20.00 PLUS THE $.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, Yes ( ) No ) and is securely supported and firestopped where required. The venting system is plastic/PVC and meets all current codes and manufacturer Yes ( ) No ( ) specifications including sizing, length, number of elbows and termination. 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 Yes () No ( ) assisted and natural draft appliances. 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. No Yes () ( ) 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 Furnace Yes () No ( ) Venting Tables for fan assisted and natural draft appliances. 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 Si z dCommon 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 It Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: Describe HEATING CO: Signed By: Date : SUBJECT PERMIT NO. City of Fridley 32358 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. ��/� y NUMBER REV GATE 12 / 12/01 PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910415 JOB ADDRESS 665 59th Ave NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 2 Donnays Lakeview Manor Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS zip PHONE Cal & Joyce Hagberg, 665 59th Ave, Fridley, MN 55432 763-571-6874 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Northridge Home Inc, 1161 Hwy 10 NE, Spring Lake Park, MN 55432 763-780-8020 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20093315 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Dwelling 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑g ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Remodel interior of home & add 3/4 bath 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plans. 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 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 $20, 000 00 @ 10 50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT W DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY THER STATE OR LOCAL LAW REGULATING CON• $ 321.25 $20 00 Fire SC STRU ION T RFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOT L FEE $5.00 c nse 36.75 T EOFC N. RAC TOA OR AUTHORIZED AGENT tDATEi ENP OP VALID THIS IS YOUR PERMIT XSMNATURE 2 : l +,0/ OF OfWNEPOF OWNER BUiLDERI IOrr E. BLDG INSP f GATE NEW [ ] Effective 1/1/2001 ADDN [ J CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ j: SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: ��S 5�9 r�} AV$ ^ik; Legal Description: , 4 T S A-, e- Z Z%*XAr & 4/41✓4-V /0AA(.PP MO Owner Name & Address: Li/G `: JoVeFr dh- 4-Aal, Tel. # 763 - 3"7/ 68 Contractor. /hpvnh� ajay 1 a r -Ne" MN LICENSE # Z4053-36- Address: 40533SAddress: //iP) / q /D Aft /1lIJ� 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 Hngt/Ground Sq. Ft. OTHER: ,Sc4pp- 0-Aweew, ` D.�'bi= Construction Type: 00� s 6� 4140— Estimated Cost: $ MF AM WA Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: /L -/,a `4 APPLICANT: Tel. # 6/7--94,3-yS/J CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ 'Qgni. OQ .001 of Permit Valuation (1/10th%) State Surcharge $ %..� $.50/$1,000 Valuation SAC Charge $ $1150 per SAC Unit License Surcharge $ 5.00 $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: of 4 mw� a, « Yao—A 777 o tj �5A I q4 i4 "d 1-4 1� ',Z IS. 2Pw of 4 mw� a, « Yao—A 777 o tj �5A I q4 i4 "d 1-4 Scope of Work To be performed at � �� hr,!- . Date: 10-6- , 20&/. Family Room — Dining Area Remove fireplace and build in TV -Stereo cabinet. Remove wood paneling, replace or resurface with sheetrock, paint. Install sheetrock in ceiling of Family Room area. Move ceiling light over dining room area — eliminate chain drop. ' Remove paneling on west end of Living Room and replace with sheetrock. Repaint living room walls & ceiling. Move ceiling light, eliminating chain. Replace exterior door left of garage. Den Install pocket door between den and kitchen. Change ceiling light fixture. Kitchen Replace existing cabinets and countertop. Replace sink, and garbage disposal. Install plumbing as necessary. Install GFI outlets in sink area. Repaint walls. Open wall over sink. Downstairs Bathroom Completely finish % bath. Includes shower, toilet and sink. Items specifically excluded from contract price are: Windows and installation of windows. Floor coverings. Light Fixtures. CITY OF FRIDLEY INSPECTION DIViSION 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 JOB ADDRESS�`— Effective On January 1, 2001 OWNER Rate TOTAL 457 -Si Si BUILDING USED AS $ 30.00 $ -�®. ESTIMATED COST PERMIT NO. $10.00 $ DESCRIPTION OF FURNACE AND OR BURN R $10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $10.00 $ Trade Name Size No. BTU HP EDR $ 25.00 $ Fuel Total Connected Load Burner Trade Name Size No. $ BTU HP EDR �rAcL rwi;w 5 ��i �Q -4 z Cornmerciai/Industrial 1.25% of Value of Appliance or Work $ 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. $ .50 3 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. 0 DATE HEATINGCO Signed TEL # EA ti Approved By Rough -In Date Final Date BACK SIDE MUST E FILLED IN ON VENT SIZE, VENT CONNECTORS m AND COMBUSTIO AIR VERIFICATION �' Effective January 1, 2003 CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572-3604 l�l-� REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES FAX (763) 571-1287 r/ .106 ADDRESS_ 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 Rate $ 30.00 $ 10.00 $ 10.00 $ 10.00 $ 25.00 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. OWNER �Gll�ih �-foy he/� TOTAL BUILDING USED AS 72QS,reo�rp $ _�tq.X ESTIMATED COST ��Uy 0(� PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units / Circle One (Steam) (Hot Water)arm Ai $ Trade Name CGi i/i e/ Size No.`s R`nr/"o BTU HP EDR $ Fuel 4z4k,,1,a/ f Total Connected Load Burner Trade Name Size No._5S/All I'Adot) $ BTU l(.()nZ;> 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 ar $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. $ �SD DATE CenterPoint Energy Minnegasco HEATING C013562 Central Ave NE, Anoka, MN 55304 SignedCVA& ks . V'�ca lq ,`,,x..763-757=6202 FAX # 763-757-6701 Approved By _ Rough -In Date Final Date �a d 63 FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED the undersigned hereby verifies that the When , tion, obstructions, venting has been examined and f i sfr a from PP where, required, Yes (X) No ( ) and is securely support The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes X1 No ( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's ncatios. foidoes include AGA-GAMA Category I CentralFurnace VentingTables Yes (X) No ( ) assisted and natural draft appliances. The evinfing namist isti n airis sized and installed to meet the current codes Yes I) No ( ) and manufacturers specifications. When required to install a new rnmhi infirm air_ It will be sized and installed and manufacturer's specifications. Yes ) No( ) to meet the current codes cye m, the undersigned hereby verifies that When installing L nM "a"t'ne e it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace and natural draft appliances. Yes f ) No( ) Venting Tables for fan assisted insta led Is the common as been removed from the commonvent and vent connectors sized v vent alnd vented correctly after an appliance Yes (X) No ( ) separately as per current codes. A*�nh n a Ty ofs- P/remman Ventnd Vent Conner nr Infnrmatinn n—A si�ited or Nat Appliance #1 Type ✓%r,J BTU Input hG. Ovb Fan Assisted or Nat - Appliance #2 Type "I -e- � -� BTU Input F Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input _ Vent Height 2 ` Common Vent Type L � - �Diameter inches ---1--- Type L i - Type GI - Type N Appliance #1 Vent Connector Height ft Length _La=ft Diameter y r in Appliance #2 Vent Connector Height t_.ft Length 2. ft Diameter n Appliance #3 Vent Connector Height _ ft Length _ft Diameter in HEATING CO: CenterPoint Energ,13562 Central Ave NE, Anoka, MN 55304 Signed By: Date: //tel �� Ceft0ftnt. Sner9Y Minnegascp ADDRESS &;`J ii, 4 OCCUPANT � HEAT LOSS Yes DATE HTG. INST. ' SOLD BY Electrical Work By TYPE OF HEAT FA SPACE HTR.^_ MAKE GAS DESIGN r�^ l fr%� Model Serial Wil(It . NPUT CONTROLS Heat Plug Limit setti no Il� Fan Settin Pilot Type _ i� Pilot Make d` Pilot Model Pilot Timina .moi' %Ie C Pressure ,,� " Percent CO2 nput CFH J�Qj `� Percent OZ ice' Stack Temp. 16 Percent CO HOUSE HEATING TEST RECORD APT� FLOO CITY I OWNER + !° INSTALLED BY CenterPoint EnergyMinnegasco Gas Line By c!;�Z,sk UNIT HTR. OTHER CONVERSION Vent Size cr KIND OF LINER 1 SIZE NONE Draft Hood Regulator Filters Size /—Number Chimney Location Inside Outside Chimney Construction Wiring Test Tag Lighting Inst. Date Tested Company Testing CenterPoint Energy Minnegasco Name of Tester Building BUILDING See Back Page for Fee Schedule Permit No.: AMC- iW ZZ Inspections RESIDENTIAL APPLICATION Surcharge Received By: 763-572-3604 CITY OF FRIDLEY $ Date Rec'd: �! Z YOUR E-MAIL A�DRMS �� ti $ DATE SAC Charge SITEADD S 6 $1450 per SAC Unit (Plans to MWCC for determination) THIS APPLICANT IS: OWNER ❑CONTRACTOR $ PROPERTY OWNER/ NAME: ADDRESS: "J� '' CITY STATEIPF 2 - TENANT $ PHONE: -74 Sewer Main Charge CONTRACTOR NAME: Total Due . STATE LICENSE N EXP DATE Make checks Pavable to: City of Fridley Attach Stipulations SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE ZIP WITH APPLICATION PHONE FAX PROPERTY TYPE V41NGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS ❑ BASEMENT FINISHPROOF ❑ DRAM TILE ❑ DECK D SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION %MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE:" SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARESJ�i2 PLHOUSE & GARAGE BASEMENT REMODELING SUBMIT: Ihg Ex Floor Plan GARAGES ❑ ACHED GARAGE 2. Proposed floor plan PROPOSED SIZE. D CHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: �/ � (p SID 3 FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑ t ❑ Aluminum Trim /+DDITIONS 1. & PORCHES SUBMIT: Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Epergy Calculations M EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION S OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Surcharge $ (.0005) times the total job valuation — Minimum $.50 Fire Surcharge $ .001 x Permit Valuation (I/10%) License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1450 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $20 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due . $ Make checks Pavable 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 a�cew 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 w ch quire an approval of plans. SIGNATURE OF APPLICANT PRINT NAME V1/P�rDATE A.V PO �bD�