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PRE 2010 DOCS• • City of Fridley, Mian. BUILDING PERMIT Date: _ July 18, 1968 Owner: Address No Builder Staber Construction Co. Address 2 -paa+ 26th Sure-,&+ LOCATION OF BUILDING p f/ar 9833 No. E75__ Street ...._..59' Ave- N . E . --- Part of Lot Lot _.._ 4 _. -- Block 2 — Addition or Sub -Division Donnayl s Lakeview Manor Add. Corner Lot — Inside Lot — Setback __ Sideyard _ Sewer Elevation __ Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Addition 20'-0" 8'-0" 151-0" 160 2¢00 Front _..._ Depth Height Sq. Ft. Cu. Ft Front Depth _ _ Height Sq. Ft. Cu. Ft. Type of Construction Frame Fst. Cost —_82500.00 __.. To be Completed Thirty Days 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 21 provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $_ QQ_ , permit is hereby granted to Sfaber___ C ons t . C o . 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 violation of any of the Provisions of d ordinances. X=p W L —Building Inspee�vr NOTICE: This permit does not cover the eonstrueHoe, installation for whine, plumbing, gas heating, sawsr or water. Be ales to sss the Building Inspector for separate permits for these hems. APPLICATION FOR BUILDING7 PERMIT CITY OF FRIDLEY, MIIMESOTA, ; OWNER,' S �. %9 �e rt: L ®„.✓s o ADDRESS LOCATION OF; BUILDING LOT. BLOCK _ �_ AD�JION OR .SUBDIVIS2ON'� { ' CORift LOT UtIDE L01f­ SETBACK $IDkYARD.. •. SEWER ET.EVATION TOP OF FOOTIM Applicant attach to .this. form Two CerS#icatea. d9 Survey .of Lot and..PXoP.o8e4, . building location..-drawa-.on these Certificates:.; : DASCRTMION• Of. -BUILDING To Be Used As. 17 :..; T�' i Z t v z�. Front`g `-. cr .ept�ii � Hgight—. • Square feetI Cubic. Feet F .. Aepth ,.; •.:�.. -Height Square feet Cubic eet o Type of Construction ' Estimated Cost C;iS0 To Be Completed 1 19 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 IY_)_h61 _SIGMA •_,.Z_ (Schedule of Fee Costs can be found on the Reverse Side. l r . 0 L - 53-84-s915.51 City ®f Fridley Approcafim for Numbkg and Sm RMing Poma Dept. of Bldgs. Phone 960-3450 DESCRIPTION OF WORK Number, Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: r FII 3rF Number Fixtures cc $g g` d Future Fixture Opening x $1.50 ,i New Fixture Old Opening r $ Catch Basin x $3.25 W Water Heater (Up to 99,000 BTU) • • WATER MTR. GAS ELEG Bax z $2.00 $. GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ..... ........ 1 x $2.00 s--2.00 Additional Fixtures ..... .............. x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ install (1) gas grill 3.00 1st -- — 2nd 3rd 4th L—Htf _ ° Future Connection Openings Coaaected with — -- -- e New Fixture, Old OpeningsSewer I Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures x $2.00 $ Future Fixture Opening x $1.50 $ New Fixture Old Opening x $1.60 $ Catch Basin x $3.25 $ Water Heater (Up to 99,000 BTU) x $3.00 $ New Ground Run Old Bldg. x $3,25 $ Electric Water Heater z $2.00 $. GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ..... ........ 1 x $2.00 s--2.00 Additional Fixtures ..... .............. x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ install (1) gas grill 3.00 REPAIRS & ALTERATIONS—Refer to Code Description .... .... ........................ .............$ TOTAL FEE $ 5.00 I.eeallaa 67K NE K9 Ave City of Fridley: The undersigned hereby makes application for a permit for the work herei speed, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct- Fridley, orrect Fridley, Minn_ Jn e 1 3, 1970 19_ Owner vera Gaupp Kind of Building frasie Used as residence To be completed about June 18r; 1970 Estimated Cost, $ 10.00 OldK-New. Building Permit No.— _ _ _ —Permit No. Si Busines±Phon o- �r�n�RirnDlll R me rr, m t ire ROUGH FINAL ' �i/ J �k vv 11T1 OF FRIDLEY RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Now Fixtures $ 5.00 $ Future Fixtures $ 3.50 S Old Opening, New Fixture $ 1.50 $ Beer Dispenser S 4.00 S Blow Off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ Hydraulic Valve S 5.00 $ Sump or Receiving Tank S 5.00 S water Treating Appliance $ 7.00 $ Hot Water Heater $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ Back Flow Preventer Required. . . Yes ( ) No ( ) Type $5.UO $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS Is of Value of Fixture or Appliance $ Reinspection Fee $ State Surcharge S .50 ($15.00) TOTAL FEE $ /6- Z Effective May 1, 1990. Job Address 6—? 'C� 5c? _Q Department of Buildings 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 Fridley, Mn. © �,+ C%� , 191?o OWNER �zdz 00 1J G A PP KIND OF BUIL(DDIING r a A M USED AS a ]irj4,LL1 0 C- TO BE COMPLETED ABOUT i Q - _q -1- 0 ESTIMATED COST ?— d (3 02 % / OLD - NEW BUILDING PERMIT NO. PERMIT NO. / j ROUGH INSP. Date FINAL INSP. Date company E C o N C w% a G n z Signed By Tel. No. °7 Cil % 14 `i GAS �)p%NG,, 10 N-cj r--u(ZN P(E R�_: PL -A c, f, ry C-jj APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBINGERMIT IS $15.00 PLUS THE $.50 STATE SURCHARG m 'n u .14 x W a Water W a9 M ►ai r •. m P. W Heater .ei v m q 3 ~ u °1e u w x g .Ci 41 W u a " 3 o u 4 3 u o lec A r r� roe 'A g. a� as 1st 2nd 3rd 4th (R) a Future Connection OpeningConnected with Sewer (�) v New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Now Fixtures $ 5.00 $ Future Fixtures $ 3.50 S Old Opening, New Fixture $ 1.50 $ Beer Dispenser S 4.00 S Blow Off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ Hydraulic Valve S 5.00 $ Sump or Receiving Tank S 5.00 S water Treating Appliance $ 7.00 $ Hot Water Heater $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ Back Flow Preventer Required. . . Yes ( ) No ( ) Type $5.UO $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS Is of Value of Fixture or Appliance $ Reinspection Fee $ State Surcharge S .50 ($15.00) TOTAL FEE $ /6- Z Effective May 1, 1990. Job Address 6—? 'C� 5c? _Q Department of Buildings 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 Fridley, Mn. © �,+ C%� , 191?o OWNER �zdz 00 1J G A PP KIND OF BUIL(DDIING r a A M USED AS a ]irj4,LL1 0 C- TO BE COMPLETED ABOUT i Q - _q -1- 0 ESTIMATED COST ?— d (3 02 % / OLD - NEW BUILDING PERMIT NO. PERMIT NO. / j ROUGH INSP. Date FINAL INSP. Date company E C o N C w% a G n z Signed By Tel. No. °7 Cil % 14 `i GAS �)p%NG,, 10 N-cj r--u(ZN P(E R�_: PL -A c, f, ry C-jj APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBINGERMIT IS $15.00 PLUS THE $.50 STATE SURCHARG CITY OF FRIDLEY Effective Date May 1, 1988 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE / RESIDEbTLAL RATE TOTAL Job Address (p 7� 16 Furnace Shell and Duct Work, Burner (Also replacement furnace) $ 20.00 Gas Piping $ 10.00 (piping needed with now furnace) Gas Range $ 10.00 Gas Dryer $ 10.00 • Air Conditioning (all sizes) $ 10.00 All Others/Repairs and Alterations It of Value of Appliance or Work COMMERCIAL/INDUSTRIAL It of Value of Appliance or Work State Surcharge Reinspection Fee ($15.00) Rough Insp. Date Final Insp. Date Approval for Permit Yb $ _;2 0,Department of Buildings, 6431 University Ave. N.E., Fridley, HN 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. $ /� Fridley, Minn. OWNER l �/�,.� / �S� /�C�1� //✓� $ KIND OF USED AS TO BE COMPLETED ABOUT /G "-J/ —76 ESTIMATED COST /y/ U (-� NEW BUILDING PERMIT NO. PERMIT NO. DESCRIPTION OF FURNACE/BURNER HEATING or POWER PIAA1NTS, Steam, Not Water, warm Air- No. Trade Name Size No. 7�S Capacity Sq. Ft. EDR BTU HP Total Connected Load Kind of Fuel —r2214� BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00- Company PLUS $.50 STATE SURCHARGE e, Signed By 4e Tel. No. *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. Fill out back side for stack verification on replacement furnaces CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack; I. Has been carefully examined Yes (,) No ( ) 2. Is free from rust or deterioration Yes ( ) No ( ) 3. Has no foreign objects lodged within Yes ( ) No ( ) 4. Is securely supported Yes ( ) No ( ) 5. Meets all current Code requirements for size and total BTU connected Yes ( ) No ( ) 6. Has Total heating BTU's of All other BTU's TOTAL Company i /� ''' sueJEcr If - IT NO. City of Fridley 27718 AT THE TOP OF THE TWINS BUILDING PERMIT 16COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. �� J NUMBER REV DATE _T PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910415 9/11/98 JOB ADDRESS VRx=n&x*x1mx&x RRxfixx 675 - 59th Ave NE I LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 2 Donna 's Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Vernon & Lora Lee Gaup A=Rxii same 571-4228 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Twin City Exteriors Co 9060 Zachary Ln N #108 Ma le Grove 55369 425-4737 2595 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 Q REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside - storm damage 9 CHANGE OF USE FROM TO STIPULATIONS Call for building wrap inspection before covering 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 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 $500.00 $.50 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 COW $21.00 FireC $.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. AC PLAN CHECK FEETOTAL F E Lic se SC 5 0 $27.00 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI EN P P D T IS IS Y BLDG SP ;PERI�AV PATE SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI NEW [ ] Effective 1/1/97 ADDN [ ] CITY OF FRIDLEY ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: __ (07,5,- 'j -r; -q _rff d 6� Legal Description: Owner Name & Address: _ _,Ve5�R,1p0 q, ,(o d��p Tel. # 6_7 - 422 R Contractor: ��,y C zv X ,Q f0kS rD MN LICENSE # Address:`ID(a 96eH42y #'fDg f&L_=r6QD&A553 Tel.# 1.12X473% 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: LengthWidth Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: Z51b e/4 iQ241 aL-= jff& Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ "TIMI WYMERIIDIT5-- DATE: APPLICANT: SUITE 108 . 9060 ZACHARY I ANI= hi Tel. # � r% MAPLE GROVE, MN 55569 CITJE�&%'Ir , Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $950 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer. Main Charge $ Agreement Necessary j ] Not Necessary [ ] TOTAL STIPULATIONS: SUBJECT P IT NO. City of Fridley 3 0 07 2 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. � COMMUNITY DEVELOPMENT DIV. r E PROTECTIVE INSPECTION SEC. 1 � i1 CITY HALL FRIDLEY 55432 '•j NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 8/18/99 10B ADDRESS 675 59th Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4. 2 1 Donna 's Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Vern Gaupp 3 CONTRACTOR Contr. MAIL ADDRESS ZIP PHONE LICENSE NO Richard Hastings/, 6331 Riverview Ter. Fridley 55432 574-9966 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 O NEW 0 ADDITION O ALTERATION AN REPAIR 0 MOVE O REMOVE B DESCRIBE WORK Reroof house and garage 22 S Tear-off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1923 .96 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 $69.25 Fire SC $1.92 PLAN CHECK FE TOTAL FEE s `. / 0' % Lice SC 5.0 .13 SIGNATURE OF CONTRACTOR OR A4kORIZED AGENT IDA EI HEN P P IIIDDAA)TE T I$ I ,' PitF1R7T (/ — .//l/I/rlCT SIGNATURE OF OWNEROF OWNER BUILDER. IDATE, BlD IN OOF RATE � ' R NEW [ ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 ®A BUILDING PERMIT APPLICATION Construction Address: "y' �= Legal Description: Owner Name & Address: Tel. # Contractor: MN LICENSE #� �} Address: 63-31 J�: 1�,2 T_ t7vZ- Tel. # Y,?q 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: 2-2- Y"- . Construction Type: ` kA Z e FF o Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: ehiVVI APPLICANT: Tel. # STIPULATIONS: CITY USE ONLY Permit Fee $ 9.14-257 Fee Schedule on Reverse Side Fire Surcharge $ j, 9o? .001 of Permit Valuation (1/10tb%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ , OD $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: "PITY OF FRIDLEY INSPECTION DIV. 431 University Ave NE 'ridley, MN 55432 763) 572-3604, FAX (763) 571-1287 oo '; q -� l L Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MAKK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR :..... Urinal Shower Wash Tray MFloor rain :..:::.... Auto. Gas Washer Range Water Heater Gas Elec nt Basement .:.::::.::......::: o FI r1 o Floor 2 Floor 3 Floor 4 'LUMBING FIXTURE RATES: Jew Fixtures )Id Opening, New Fixture leer Dispenser Ilow Off Basin ;atch Basin Iain Water Leader ;ump/Receiving Tank Vater Treating Appliance Vater Heater -Electric Vater Heater - Gas** NO. RATE TOTAL JOB ADDRESS '45C n R_ - a.S ow A>td- _ I Sas Range** las Dryer** lack Flow Preventer Required ( )Yes () No Type $10.00 $10.00 $10.00 $1.0.00 $10.00 $10.00 $10.00 $35.00 $35.00 $35.00 $10.00 $10.00 $15.00 teinspection Fee $50.00/Hr kLL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge TOTAL FEE The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the Building Division, and hereby declares that all the fads and representations stated in this application are true and correct. GAUPP, VERNON 675 59TH AVENUE NORTHEAST/3l 20_125 FRIDLEY, MN 55432 OWNER (763) 571-4228 36. db BUILDING USED ASST d eytc� ESTIMATED COST V0 PERMIT NO. PLUMBING COMPANY NO C O ` OWk UAA1 i SIGNED BY '�� 2�z� TEL N0. ((o 12) 927-cl033 Approved By Rough -In Date Final Date $ jE-SD OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. COMBUSTION 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 verges 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 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 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: ImFrom: City of Fridley To: 6519051745 Page: 3!4 Date: 10/2/2007 3:27:01 PM `, MO AND MATERIALS: BUILDING (USING 1997 Permit No.: Inspections VALUATION $ RESIDENTIAL APPLICATION Received By: 763-572-3604 See Back Page for Fee Schedule CITY OF FRIDLEY Date Rec'd: DATE YOUR E-MAIL ADDRESS $ SITE ADDRESS 1 i 1. $7j .0005 x Permit Valuation Minimum $.50 License Surcharge $ THIS APPLICANT IS: ❑ OWNER J1CONTRACTOR $ PROPERTY OWNER/ NAME: 11 $ F ADDRESS:WI G - �J k e N E _ PTY -i j _ CSTATE6' kIP�WW TENANT $450 Conservation Plan Review PHONE: J �j) 9J _L;-71 " WZeZ - $ COINTRACTOR NAME:1iNIRI00NI al\CaL OP MIS' $ STATE LICENSE # EXP DATE ®L D 'qE & STATEIJZIP ? SUBMIT A COPY OF YOUR STATE LICENSE. ADDRESS: One -D • ft CITY -,aW WITH A2PLICATION PHONE (I ��� FAX 1JJ PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED -99 WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TELE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE(REP.AIR ❑ REMODELING DESCRIBE WORK BEING DONE: r-�> QC -e U W i WWS SdW)-CJ S I Ze, SIZE OF IMPROVEPvtENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGJKS ❑ ATTACHED GARAGE 1. Existing Floor Plan 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. Fc PORCHES SLBMIT: ❑ Ahunirntm ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. WIPIDOfi1,S 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations OR FORiNEW OPENINGS -DESCRIBE SIZE OF OPENING CHAN. & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS .ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ — OCCUPANCY TYPE Permit Fee $ 0 a s , 3 5 See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $7j .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1675 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21 =$ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer MEin Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ 1' e;-1 . ' 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 applic ' n for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan inthe case of all Wo whir a review and approval of plans. 'r, c� SIGNATUSE OF APPLIC PRINT NAME W RC�[_1( 2- DATE 'f / 1 0 3 From: City of Fridley To: 6519061745 Page: 3/4 Date: 10/2/2007 3:27:01 PM uilding BUILDING Permit No.• . —� Inspections RESIDENTIAL APPLICATION Received By: -S, 763-572-3604 CITY OF FRIDLEY. Date Rec'd: CP— �i —b DATE_ YO -1LkZ AD 1 SITE ADDRESS 44 3nT--!n yk-e �\"t THIS APPLICANT IS: ❑ OWNER >�NTRACTOR PROPERTY OWNER/ NAME: ADDRESS:. *dam--` �!qt i STATP"YPy TENANT PHO CONTRACTOR NAME: _ STATE LICENSE # EXP DATE SUBMIT A COPY OF ��0 L<5A7t� 'Ca / STAT YOUR STATE LICENSE ADDRESS: TY WITH A- PLICATION WITH O 4 S`� FAX PROPERTY TYPE ASWGLF FAMILY/NEW CONSTRUCTION SIZE . TWO FAMILYtNEW CONSTRUCTION STORIES PERNUT TYPE ❑ ADDITION ❑ GARAGEISHEDWS ❑ BASEMENT FINISH ❑ROOF DRAIN TII.E ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ DITION DBAUDITENANC-FMPAIR G DESCRIBE WORK BED& DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGIES ❑ ATTACHED GARAGE 1. 2. Existing Floor Plan 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 SLBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. WIPIDO�VS 2. Two sets of construction plans 3. Energy Calculations IN EXISTING OPENINGS es ONo LOC/JRPV OF W[NDOWS ORFOR .NEW OPENINGS SCRIBE SIZE OF I�� 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 THF.1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ OCCUPANCY TYPE Permit Fee $ 5 See Back Page for Fee Schedule, Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ \ t 3a .0005 x Permit Valuation Minimum $.50 License Surcharge $ "do $5.00 (State Licensed Residential Contractors) SAC Charge $ $1675 per SAC Unit (Plans to MWCC for determination) Curr Cut Escrow $ ft + 6 ft = ft x $21 =$ Erosion Control Park Fee Sewer Main Charge Total Due $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary Make checks Davable to: Citv of Fridley THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED Attach 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 'W not to start without a permit; that the work will be in accordance with the approved plan in -the case of all or ich fres review an pprov of plans. �� � SIGNATURE OF APPLICA PRINT NAME /i`? DATE