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PRE 2010 DOCSCity of Fridley SUBJECT 76768 AT THE TOP OF THE TWINS B U I L D I N G P E R M I T r REC 0. ' COMMUNITY DEVELOPMENT DIV. ,.--•---. PROTECTIVE INSPECTION SEC. 7� o r I �O i--••� ��---``� CITY HALL FRIDLEY 55432 L NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 9/16/82 JOB ADDRESS 401 - 63rd Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 23 1 Alice Wall Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Rodney Billman Inc. 151 Silver Lake Road, New Brighton 633-0536 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 ElREPAIR ElMO E X 8 DESCRIBE WORK Before dining Construct a 24' x 40' Dwelling and a.22.5' x 241 Garage_ telt kcal atil` 9 CHANGE OF USE FROM TO LAI STIPULATIONS Provide a hard surface driveway. Provide City with copy of verifying survey before capping. Provide sod in the front and side yards. SEWER LOCATION: (.Approx. 5' Deep on Prop. Line) 83' E. of M.H. at 5th Street and 63rd Avenue (Inv. 844.26) WYE ELEVATION: 843.92 TOP OF FOOTING: 846.92 Minimum WATER LOCATION: 95.9" E.N.E. of N.H. at property line. Approx. 2' West of sewer service. DRIVEWAY DEPRESSION ESCROW: N/A >a+t atar or r,4ao►M pec *ror C SEPERATE PERMITS REQUIRED FOR WIRI PUAMMM ACCU"C'r cr U" WCAMM Awe ratyAvc: BEATING, PLUMBING AND SIGN& 711123 DATA I3 " WOWARCM PVRFG'.�5 4Ntir Ahi l X15 USING R SWUW 1VEMY TM! QattOUAT*N N �E SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. Wood Frame THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $53,450 $26.73 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. $295.00 $425.00 TR TION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE 1i�-/1-�1-, $73.75 $820.48 GNATUREOF CON ACTOR OR AUTHORIZED AGENT (DATE) * _ WHEN PROPER VALIDATED THIS IS YOUR PERMIT c0 L- BLDG INSP r)AVE G E F OWNER t OW R BUILDERI IDATEI as NG, CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATIM FOR RESIDENTIAL BUILDIf1G PEMITS (NEW. Alterations, Additions, or Repairs) OWNER: ADDRESS: TEL N0: BUILDER: r ADDRESS: cSi�lle�ifi� TEL NO: Ezz • Construction Location • STRICT NO: - STREET: tL� Z�2 LOT: "� .3 BLOCK: - ,� ADDITION: Corner Lot: ✓ Inside Lot: Setback: Sideyards: 2,/ Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION _ Front: _a-���Depth: Y, Ze, Height: IV Squa- - Feet: Cubic Feet: Front: Depth: Height: Square Feet: / D 7 Cubic Feet: Type of Construction: �� � Estimated Cost: '!b Be Oor.�pleted: L �/ Alt. A Alt. B Proposed Drivc��ay kidth If New Opening Is Desired: ,f t o $ ' $ SEE REVERSE SIDE OF SHEET . Mie undersigned hereby makes application for a permit for the work' herein specified, agreeing to co,all work ir, 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 a true and correct. DATES —Z—e - 'Z SIGNATURE: Stipulations: 9�� r �� Ty 0 0 -7 , HARRY S. JOHNSON COMPANIES, INC., • 401 WEST 79TH'STREET •_� .� - BUQOMINGTON. MINNESOTA 55420 1 %AD �.• PHONE 16121 664-5341 • Ij10.01� * ~ S ^�EAiT 40CERTIFICATE OF SURVEY a`��''2°'t`.•: N 87 9`S3 v!oFORWALL GONP 31.0`1� . iQ101. A1,1•. V6A9%13b15 OP90ifi:0 _ON.. p AOME�_vA►T4tM n 1 9 0 I 120.01 - O1 10 p W O ,� X oar-aW f 1="Tif`f T>3Ar .TNIes_.15 A Y(LLlE _.._ .. i v j 28.64 T: • O Atip% GDizIZEG'j' 2P.etG-��N'[PcT1oN' of --A__. i�INe9�s9's3"w jn CURVEV . 4F THE 6atJNDAMMI of I.o'Ix [�i .... i 12ao1 8-", ea -K 1, oF'r4M ALIG13 WALL ADa1TIoN, NEIUNEPIM GouNT`i, M1rJIl11:SoTA,, >wl o Ay SuvEY�ry fes(' ME TF11S 9*-`� aaY 8 0l a $ Q ,ro SN W MPRoVEMf5#4T<i oR. �NGRo LH�PdRT " 0 27.64 .MF— TS IIF AW(O. '. I /'=N890509'33"w M s, _ — 1 � 024 1 •• 00 ? 0 1 `G O a - Ad I HARR� •. w �lzsas " ' LTJ LANs? guR�ik`(o1Z:.: Ns9�s933w t., A T10� `"iG.1 120.01 .r 401 C. A qt4 �1 lot 81 01uEL wo�2s0s tip oils oejD5ly iN+ ElEpyNEO'vt 0 N g�i1g I�-i o 1 o =�� J i ti 1 24.87 ~ •� ..� •'C AU T-1 0 rwi ; 120.01 F'VFSION SAFETY CONTROL ZONE" sbbt - a arae- a 1 I y�iAT .. Do NOT PANT OR PLA; THIrJ IN'.THIS' ARcEA iI7Ff 1 f - ' FROVAL OF THE:CITY OF t '+'���{• N e9•ss'i!"w • �� 1 1lOrDl ',,,. . O •N 69"9.33w T =` 3 ' _so. _ _-ss-0o_ _ _ _75.00_ _ _ 75.00_ 94.19 _ _ _ -41-'7 5.00 -': J 16 o • ' I ''"" 13 1 N n'ss'!!ti I w 11 S ■ 1 1 120A1 w. $ "22 21 _M�20 1_--o 19 :� 16 0 ■ �i ; 'l43" s O of b x • �.° •alto n , a -•i a•90 moi; o !a �. 75.00 75.00 73.00 94.32 78.00 P3 9671 6027 664.53 1409°59'33"W �•`%.E - : •t....,.• _. _.--� g3 L111 D' 1 s. 4 EXTERIOR ENVELOPE AVERAGE "U" COMPUTATION OWNER - T SITE ADDRESS A74`1 CONTRACTOR. -DATE PHONE 4 3 3 --®J�.�� Determine working square footage of each. J 1. Total exposed wall area . . . . �sq."ft. x,1Z _ 2-�� 2. Total roof/ceiling area . .sq. ft. Total exposed wall area above floor a. Total wall window area .......................... /V r b. Tetal door area ................................ 40 c. Total sliding glass door area ................... ®® d. Total fireplace wall area ....................... p --y --- e. Total wall framing area (average -10%) ........... � —_7 f. Total net wall area above floor ................. 7?/ g. Total rim joist area . .........................._U f Total exposed foundation area = I'l -I- h. Total founfttion window area...... .............. �?✓ i. Total -ir-area above grade........... L W.4 A R E.,a be) -,w Determine "U" value of each wall segment. a. X ..0 If b X -,U _ L re e ® I e. X flu It f. f 7.1, X --U gs X flu of h. X flu It J 3 ZJ 7/f 3. ........Total = �� Total exposed roof/ceiling area m. Total skylight area ............................ �. O n. Total roof/ceiling framing area (.average 10%)... i o o. Total net insulated roof/ceiling-area........... Determine "U" value for each roof/ceiling segment M. ® ® X $full ®® D n. ® X flu11 4 ........................... Total - J� If t-ot:41 of ¢;4 is the same as, or less than #2, you have met the intent of ' �1;13C 6006 (c) 1. Alternate Building Envelope Design To utilize the total envelope system method, the values established by the sum of itc.ic 1"13 and ;14 shall not be greater than the suin of items Jil and #2. 3. 3 �� 1 4. � 7. J 1 n If ** * PIONEER * ®ng n®®r *4* * 2422 Enterprise Drive Mendota Heights, MN 55120 LAND SURVEYORS • CIVIL ENGINEERS 11 (651) 681-1914 FAX: 681-9488 LAND PLANNERS • LANDSCAPE ARCHITECTS 625 Highway 10 N.E. Blaine, MN 55434 (763) 783-1880 FAX: 783-1883 Certificate of Survey for. MERIT BUILDING CO. INC. House Address: 401 63rd Avenue NE 852.1 1 E2 Nr85240.00 no I I EXISTING BUILDING N8 a59'W!W-----� 851.7 Ex Fence c -- --- -----------SHED $ a. 852.4 EX. � �,d 23 5 Is 852.3 852,4 852.2 852.4 852, 851.6 V10.00 28.00 13.99 851.8 _ agd aCd 852.0 22 1 •DO 852.0 0 Cj0 TOP OF BLOCK = 852.1 PROPOSED HOUSEGARAGE 5 CRS. BSMT. I 18.33 852.1 f FENCE - TDP OF PIPE 851.5 rr n EL v 852.07 I x 851.6 x 31 �2Q 851.1 R% 43 I N 6.83 8r -1 31.83 851.9 gn 851.7 po a'• i852.6 DRIVEWAY L ¢ BENCHMARK 3%b - TOP OF PIPE \fl m EL = 851.67 I g� Ts 851.0 \ I ❑O TV SIDEWALK 1850.6 850.6 D'8ga2�j 850.9 60.21--` N89059'33"W 63R,D /-`-� 850.4 �T r Y AVENUE NIva+e •. sem+- �o��e pew f ec r �o,�' c•�c1 u:,1 � C�e�c� Svm-e CIA Is C, L"GI gre,cl; 000.o c,c' Denotes Emergency Overflow x 000.o Denotes Existing Elevation x� Denotes Proposed Elevation Lowest Floor Elevation:8 y 9 , 8 Denotes Drainage Flow Direction Top of Foundation Elevation: A3 == Denotes Drainage do Utility Easement Garage Slab Elevation: 852.6 (at door) -a- Denotes Monument NOTE: Proposed building site grading to in accordance with the t Denotes Offset Iron Bearings shown are assumed grading plane approved by the city engineer. NOTE Contractor must verify all dimensions do driveway design. LOT 23 , BLOCK 1 , ALICE WALL ADDITION ANOKA COUNTY, MINNESOTA We hereby certify to MERIT BUILDING CO. that this survey, plan or report was prepared by me or under my direct supervision and that I am a duly licensed Land Surveyor under the laws of the State of Minnesota. Dated this ( I -I day of AT A.D., 2002. Signed: PIONEER ENGINE RKG, P.A. Scale:l inch = e 30f- BY t Terrence E. Rothenbacher, L.S. Reg. No. 20595 202073.01 JPS Thomas R. Balluff, L.S. Reg. No. 40361 CITY OF FRIDLEY APPLICATION FOR PWMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 5.00 $ S , 0 0 Future Fixtures m $ iU $ 1.50 $ Beer Dispenser $ 4.00 m Blow Off Basin Water my Catch Basin m $ Rain water Leader $ 5.00 $ r mm $ Sump or Receiving Tank +�+ wo w a $ Heater _� $ 5.00 $_ S O O Gas Range $ 10.00 +Oyll Gas Dryer $ 10.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS pM It of Value of Fixture or Appliance $ S`®, ® O Reinspection Fee $ State Surcharge $ .50 ($15.00) TOTAL FEE $ 5,0.3-0 O O Ny yym +MIR b .••U1 OL�pp qmq N m m imp {� W 13 a Al 00 0 3 L] w W U IA 3 (7 O ec 2nd 3rd 4th (R) a Future Connection Opening Connected With Sewer (�) - New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 5.00 $ S , 0 0 Future Fixtures $ 3.50 $ Old Opening, New Fixtuge $ 1.50 $ Beer Dispenser $ 4.00 $ Blow Off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain water Leader $ 5.00 $ Hydraulic Valve $ 5.00 $ Sump or Receiving Tank $ 5.00 $ water Treating Appliance $ 7.00 $ Bot Water Beater _� $ 5.00 $_ S O O Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance $ S`®, ® O Reinspection Fee $ State Surcharge $ .50 ($15.00) TOTAL FEE $ 5,0.3-0 aLLecclVe Aug. 1, 19tll Job Address Department of Buildings City of Fridley Tel. 9571-3450 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. OWNER l L Z ! j � A ( E52 AJS i -I- KIND LRIND OF BUILDING tt-o—y-` USED AS rt% ��v !w J e- �r C TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. Company Signed BY Tel- No. ��/- d 73 3 ROUGH INSP. Date FINAL INSP. 5--1 C/ - 83 Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00 PLUS THE $.50 STATE SURCHARGE SUBJECT MIT NO. City of Fridley 2 6 72 AT THE TOP OF THE TWINS BUILDING PERMIT r ` RECEIPT NO. __ COMMUNITY DEVELOPMENT DIV. i it -------- -- PROTECTIVE INSPECTION SEC. r � 1 � � NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910415 17/21/98 JOB ADDRESS 401 63rd Ave N I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 123 1 1 Alice Wall Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO L & L Contractin Inc. 151 Silver Lake Rd #7 New Brighton MN 55112 697-9455 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20139735 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION $1 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage 29 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2418 $1.20 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- Fire SC $2.41 S PERFORMANCE OF NSTRUCTION. $74.75 A�UCTIONORTHE PLAN CHECK FEE TOTAL FEE �— 7-21-f License SC $5.00 $83.36 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI L WHEN�PR/O�PERLY t"V 84INSP LI=DAA�/TT D THIS IS YOUR PERMIT CIO- v FATE SIGNATURE OF OWNER OF OWNER BUILDER$ IDATEI NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: 401 (a 3 r"C( / v Legal Description: Owner Name & Address: Tel. # Contractor: 2--/-/- C�..�� c e. MN LICENSE # Z o 13 S 7 3 Address: Jjre 2cf 7 k1f , tno snit Tel. # S; -5 -- Attach 5Attach 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: Ira d a J r r&ck( GL M&'5< OL Q a, z.4 p 2- J s5 , Construction Type: Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: -?-'It- 5 8- APPLICANT: r- Tel. # ZIP f 7 Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control CITY USE ONLY $ , % Fee Schedule on Reverse Side $ `�� .001 of Permit Valuation (1/10th%) $ / 0 $.50/$1,000 Valuation $ $1000 per SAC Unit $. (C) $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review Park Fee $ Sewer Main Charge TOTAL STIPULATIONS: Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] J ' • SUBJECT PERMIT NO. City of Fridley 32340 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. w______ . COMMUNITY DEVELOPMENT DIY. r � PROTECTIVE INSPECTION SEC. 1 ; CITY HALL FRIDLEY 554$2 NUMBER REV GATE PAGE OF APPROVED BY 612-571-3450 910-F15 11/26/01 JOB ADDRESS 401 63rd Avenue NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 23 1 1 Alice Wall Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE David Miller, 401 63rd Avenue, Fridley, MN 55432 763-586-0822 J CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO David Miller (same address) 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Dwelling 7 CLASS OF WORK E NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside house & garage 9 CHANGE OF USE FROM TO STIPULATIONS Per Section 1402, 1997 Uniform Building Code requires that a nRaI-tx weather - resistive barrier be placed over exterior sheathing to protect the interior wall covering. Exceptions for this provision would be if sheathing is an approved weatherproof panel or when the siding is an approved weather barrier. Vinyl siding is not a weatherproof covering unless the manufacturer states this in the application guidelines. Call for inspection of wrap before covering. 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 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 $5,000.00 @ $2.50 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 ;711FEE 8.75 }-,SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI �� f l- zG- `/ EN ROP VALID&T&0 THIS IS YOO PER%�T l ���(Fj — D� S1GNNAA'°URE OF OWNER,IF OWNER BUILDERI IDATEI BL IN- PATE NEW [) Effective 1/1/2001 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg lnsp ALTER [ ] SINGLE FAMILY AND DUPLEXES R4 AND R-2 BUILDING PERMIT APPLICATION Construction Address: L'<91 6 3e� five - Legal Description: Owner Name &Address: 0ay.ci /?'/116- Tel. # 763-5"86-6&2z Contractor: MN LICENSE # Address: Tel. # LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Lengtfi� Width p Hgt/round Sq. Ft. ru Construction Type: S d, h9 h6 use Estimated Cost: $ 6, goo OL' Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ =$ DATE: 1�7 Z6 - O I APPLICANT -,R -OV Tel. Tel. # 'IG3•5-ff/ r'Y2 2 - CITY CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ ///.-247 Fee Schedule on Reverse Side Fire Surcharge $ 6706" .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1150 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 $ l 8 • S� STIPULATIONS: NOTICE OF STRUCTURE FIRE To: Building Inspection Assessing Water Billing From: Ralph Messer, Fire Marshal Date: January 7, 2002 Subject: Fire Damaged Structure Location of Fire: 401 63`d Avenue, N.E. 415 63`d Avenue, N.E. Date of Fire: January 6, 2002 Other pertinent details: • 401 63`d Avenue, N.E.: Structure of origin. Structure also damaged by an explosion of unknown origin. The rear of structure was partially razed at the direction of the Fire Department for extinguishment. Not repairable. • 415 63`d Avenue, N.E. Fire communicated to this structure. Considerable damage but believed to be repairable. Uninhabitable and not occupied at this time. Four fire departments assisted Fridley with this fire. Those departments included Columbia Heights, St. Anthony (under the Automatic Aid agreement), New Brighton and Brooklyn Center. Although both structures were occupied at the time of the fire, no injuries were reported to either occupants or firefighters. If you have questions concerning this fire, please contact me at x3621 or Asst Chief John Berg at x3611. G7YOF FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287 January 9, 2002 Mr. David J. Miller 40163 Avenue NE Fridley, MN 55432 Re: Fire Damaged House & Garage at 40163 Avenue NE, Fridley Dear Mr. Miller: On January 7, 2002, an inspection was conducted to determine whether the above noted building was damaged to the point of being a hazard. Per Section 102 of the 1997 Uniform Building Code, which states in part, any structure that constitutes a hazard to safety, or health, or public welfare by reason of disaster or damage, shall be considered unsafe. All unsafe buildings shall be declared a public nuisance and shall be abated by repair or demolition as referenced in the Dangerous Building Code. Section 302 of the Dangerous Building Code states that any building or structure which has any or all of the conditions or defects herein described shall be deemed a hazardous building, provided that such conditions or defects exist to the extent that the life, health, property or safety of the public or its occupants are endangered. The following items deem the building to be dangerous: 1) Whenever any portion thereof has been damaged by fire, earthquake, wind, flood, or by any other cause, to such an extent that the structural strength or stability thereof is materially less than it was before the catastrophe and is less than the minimum requirements of the Building Code for new buildings of similar structure. 2) Whenever any portion or member or appurtenance thereof is likely to fail, or to become detached or dislodged, or to collapse and thereby injure persons or damage property. David J Miller Re: 40163 Avenue NE January 9, 2002 Page 2 3) Whenever any portion of a building, or any member, appurtenance or ornamentation on the exterior thereof is not sufficient strength or stability, or is not so anchored, attached or fastened in place so as to be capable of resisting a wind pressure of one half of that specified in the Building Code for new buildings of similar structure, purpose or location without exceeding the working stresses permitted in the Building Code for such buildings. 4) Whenever any portion thereof has inracked, buckled or settled to such an extent, that walls or other structural portions have materially less resistance to winds or earthquake than is required in the case of similar new construction. 5) Whenever, for any reason, the building or structure, or any portion thereof, is manifestly unsafe for the purpose for which it is being used. 6) Whenever the building or structure, exclusive of the foundation, shows 33 percent or more damage or deterioration of its supporting members or 50 percent damage or deterioration of its nonsupporting members, enclosing or outside walls or coverings. 7) Whenever the building or structure which, whether or not erected in accordance with all applicable laws and ordinances, has in nonsupporting part, member or portion less than 66 percent of the strength, fire resisting qualities or characteristics or weather resisting qualities or characteristics required by law in the case of a newly constructed building of like area, height and occupancy in the same location. 8) Whenever any building or structure, because of obsolescence, dilapidation, deterioration, damage, inadequate exits, lack of sufficient fire resistive construction, faulty electric wiring, gas connections or heating equipment or other cause, is determined by the Fire Marshal to be a fire hazard. 9) Whenever any building or structure is in such a condition as to constitute a public nuisance known to the common law or in equity jurisprudence. Per Section 403 of the Dangerous Building Code, you are hereby ordered to demolish the entire structure, including the foundation, because of the extreme damage to the building. Demolition shall be completed within seven (7) days after the City of Fridley Fire Investigation. The demolition shall be coordinated with Ralph Messer, City Fire Marshal, to assist with his fire investigation. Please also notify your insurance company of this requirement and encourage them to call my office is they have questions regarding this matter. David J Miller Re: 40163 Avenue NE January 9, 2002 Page 3 This building has been posted as an unsafe building. Prior to demolition, a wrecking permit must first be obtained from the City. All demolition debris must be removed from the site and the excavation filled with clean fill. The water meter must be removed for the reading and the utilitiy lines capped at the property line. If you have any questions concerning this matter, please feel free to contact me at 763- 572-3602. Sincerely, ZAM�) ja-4z�- W)N JULKOWSKI A* Building Official RJ/mh CC: Ralph Messer, Fire Marshal Scott Hickok, Community Development Adm Fritz Knaak, City Attorney January 30, 2002 Mr. David J. Miller 40163 Avenue NE Fridley, MN 55432 Re: Hazardous Building Located at 40163 Avenue NE, Fridley Dear Mr. Miller: On January 7, 2002 the above noted building was declared and posted as a dangerous building. Per my letter dated January 9, 2002, the entire structure, including the foundation must be removed within seven days after the City of Fddley's Fire Marshal investigation. The City has completed their investigation and all other investigators have been verbally ordered to complete their investigations by February 1, 2002. Demolition shall be completed no later than February 8, 2002. If you have any questions concerning this matter, please feel free to contact me at 763- 572-3602. Sincerely, RON JULKOWSKI Building Official RJ/mh CC: John Berg, Assistant Fire Chief Scott Hickok, Community Development Adm Fritz Knaak, City Attorney Shawn Beckler, State Farm Insurance Julkowski, Ron From: Smith, Sherree Sent: Wednesday, January 30, 2002 1:20 PM To: Julkowski, Ron Cc: Hintz, Mary Subject: 401 63rd Ave. The insurance info. for David J. Miller of 401 63rd is as follows: State Farm Fire & Casualty Co. Shawn Beckler, Claim Specialist 651-653-2375 1055 E. County Rd. E Vadnais Hts MN 55110 SUBJECT P MIT NO. City of Fridley WRECKING 3 2 418 AT THE TOP OF THE TWINSI PERMIT r R COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. 1 � = CITY HALL FRIDLEV 55432 NUMBER REV DATE PAGE OF APPROVED By 612-571-3450 910-F15 2/6/02 JOB ADDRESS 401 63rd Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 23 1 Alice Wall Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE David Miller, 401 63rd Ave NE, Fridley, MN 55432 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO RJK Contracting, 7901 Beech St NE, Fridley, MN 55432 763-717-0334 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE CR REMOVE 8 DESCRIBE WORK Demolish building (40' x 24' House and a 30' x 26' Attached Garage) 9 CHANGE OF USE FROM TO STIPULATIONS Call Gopher State One at 651-454-0002 for utility locations. Call all utilities for disconnects before wrecking/moving structure. Remove all demolition debris from the property including the foundation. Sewer & water lines must be cut at the stop box. 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 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 1 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 aE COMPLIED 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 STATE OR LOCAL LAW REGULATING CON- PROVISIMOFCON-RACTOR $27.50 STRUCTRMANCE OF CONSTRUCTION �7.50 PLAN CHECK FEE TOTA FEE SI0. AUTHOR ED AGENT iDATEP HEN ROPE VALIDATTHIS IS YOUR ERMIT �'�� _ 07/ S-GNATURE OF OWNER OF OWNER BUILDER) iDATE BL -NSP --Z OLTI, Effective 1/1/01 CITY OF FRIDLEY MOVING [ ] WRECKING V4 PERMIT APPLICATION 6431 University Ave NE Fridley MN 55432 (763) 572-3604 Job Address: /O l 6 3 °A�- II E Legal Description: Owner & Address: -A Tel. # Contractor:�z (JC3V1-f-^("G�, -)y Tel. #7/?- 033y Address: GfO � l icr_ c ST /t G- State License # DESCRIPTION OF WELDING HOUSE: Length Width Height Sq. Ft. fp7 Cu. Ft. GARAGE:Length X30 Width Height Sq. Ft. Cu. Ft. OTHER: Length Width Height Sq. Ft. Cu. Ft. Estimated Cost $ Approx. Completion Date CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. CALL ALL UTILITIES FOR DISCONNECTS BEFORE WRECKING/MOVING STRUCTURE. Water Bill Paid: Yes [ ] or Collect [$ Moving Route: ] Signature The undersigned hereby makes application for a permit to wreck/move the building described above, agreeing to do all work in strict accordance with the City Ordinances and rulings of the Building Division, and the State Code which requires any water well on the property to be sealed by a State licensed water well driller, and hereby declares that all facts and representations stated in this application are true and correct. ALL Moving Wrecking Principle building into Fridley .... $300.00 For each 1,000 cubic feet or fraction ...... $1.25 Accessory building into Fridley ... $ 42.00 For structures which would be impractical to Through or within the City ...... $ 20.00 cube, the fee shall be based on the total cost Move a building out of City ...... $ 20.00 of wrecking at the rate of $6.00 for each $500.00 or fraction. PERMIT FEE: MINIMUM $20.00 STIPULATIONS: i SUBJECT MR -MIT NO. City of Fridley - 32537 AT THE TOP OF THE TWINS BUILDING PERMIT 16 RECEIP N . COMMUNITY DEVELOPMENT DIV. 1 L PROTECTIVE INSPECTION SEC. r I `._-. w/"�,•i CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY L J\ 612-571-3450 910-F15 4/25/02 r JOB ADDRESS 401 63 Avenue NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 23 1 Alice Wall Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dave Miller 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Merit Building Co Inc 3029 Coon Rapids Blvd #311, Coon Rapids MN 55433 20271430 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 763-323-7363 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO EI USE OF BUILDING Residential 7 CLASS OF WORK J NEW O ADDITION O ALTERATION O REPAIR ❑ MOVE O REMOVE B DESCRIBE WORK Construct a 42' x 33' Dwelling and a 24' x 42' Garage 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. Provide City with a copy of a verifying survey before capping. Provide sod in the front and side yards. Provide a hard surface driveway. Sewer & Water locations per the City Engineering Dept. SEPARATE PERMITS WARNING REQUIRED FOR: Before digging call for WIRING HEATING all utility locations PLUMBINd AND SI&S 45"002 REQUIRE® BY LAW 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 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX Fire SC AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $122,063.40 $56.03 $112.06 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER ST TE OR LOCAL LAW REGULATING CON- 122.55 Credit STRUCT R E PERFORM CE OF CONSTRUCTION $1, PLAN CHECK FEE TOT L FEE License C $5.0 $1,295.64 SIGNA EOFCONTRA TORORAUTMORIZEDAGEN1 IDATEI EN PROP VALID T THIS IS YO R P IT S-GNATUREOFOWNERIIFOWNERSUILDERI IDATEI Bl0 INSv - pA fE i NEW CITY OF FRIDLEY Effective 1/1/2002 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: '401 —&5 r-4 Ave -f" I'd (-e Legal Description: 1o+- Z 3, Btdok,1 191jce. WC, If ISNdi+%dn d n(3Kcl CO M n Owner Name & Address: DaV f. M 11' er SG m C Tel. # Ul Z Contractor. M e r; -t- -act j I din C4 C.O . 1 t) O . MN LICENSE # Z® 2-71 H 3 C) Address: 300 q Coon l ea P 6 81 vd * 31 I , Cc)cn 0Wj'cb h11) 5 L/ 33 Tel. # 763 - 3 Z3 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 y ? , Width 3 5' Height Sq. Ft Z (' Z Z- /5: ?,v 4 GARAGE AREA: Length 'LIZ' Width 2-y Height Sq. Ft DECK AREA: Length Width Hgt/Ground Sq. Ft OTHER: ZkGF4;�05;w �J/ ID 9� Baa ®c 1�0 Construction Type: QeuJ 5incAle- -fo-ml ly 14nme Estimated Cost: n1a. Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ =$ DATE: Lt -14 - o z— APPLICANT: Tel. # 7&3 -37,1- 73 6 3 Call (763) 572-3604 for Permit Fees if mailing in application or Fax to 763-571-12 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee $ � Fee Schedule on Reverse Side Fire Surcharge $ I / a ® .001 of Permit Valuation (1/10th%) State Surcharge $ 6-&, 0 $.50/$1,000 Valuation SAC Charge( Q/ $ � . Q 5 $1200 per SAC Unit License Surcharge $ S,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 $ 9 STIPULATIONS: ppR 0 4 20 MNcheck COMPLIANCE REPORT Minnesota Energy Code MNcheck Software Version 2.0 Minnesota Department of Public Service 1-612-296-5175 1-800-657-3710 COUNTY: Ramsey STATE: Minnesota ZONE: 2 CONSTRUCTION TYPE: Single Family DATE: 4-1-2002 DATE OF PLANS: 4-1-2002 TITLE: MILLER Residence, Plan #tco22002 COMPLIANCE: PASSES Required UA = 317 Your Home = 273 Permit # Checked by/Date Area or Insul Sheath Glazing/Door Perimeter R -Value R -Value U -Value UA ------------------------------------------------------------------------------- CEILINGS: Raised Truss 1242 38.0 0.0 32 WALLS: Wood Frame, 16" O.C. 1896 19.0 2.0 98 GLAZING: Windows or Doors 201 0.350 70 DOORS 80 0.350 28 BSMT: 4.0' ht/3.0' bg/4.0' insul. 608 10.0 45 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet t e r r ments of the Minnesota Energy Code. Builder/Designer Date `�2 NEW HOME FIELD INSPECTION ENERGY CHECKLIST MINIMUM REQUIREMENTS (CATEGORY 2) FOUNDATION: [ ] Exterior foundation wall insulation installed: R- [ ] Slab -on -grade insulation installed: R- [ ] Ducts in slabs have R-5 insulation bottom and sides PENETRATIONS: [ ] Window and door frames sealed [ ] Framed wall openings into attic sealed [ ] Other joints in wall sealed [ ] Dropped ceiling air -blocked [ ] Plumbing penetrations sealed [ ] Exterior walls behind tub and shower sealed [ ] Plumbing vent stack sealed [ ] Chimney flues sealed at ceiling [ ] Perimeters of all grills and registers sealed to vapor barrier [ ] Electrical service sealed ( ] Recessed light fixtures sealed [ ] Wire penetrations into attic sealed [ ] Telephone, cable TV penetrations sealed [ ] Fans sealed where vapor barrier penetrated OPTIONAL (CATEGORY 1) [ ] Foundation rim joist sealed airtight [ ] Upper story band joists sealed airtight [ ] Ceiling poly sealed to top of interior partition walls [ ] Electrical boxes sealed to vapor barrier [ ] Fan housings air sealed NEW HOME FIELD INSPECTION ENERGY CHECKLIST PAGE 2 MINIMUM REQUIREMENTS (CATEGORY 2) INSULATION: [ ] Vapor barrier installed [ ] Interior foundation wall: ( ) Vapor barrier installed ( ) Insulation installed: R-_ ( ) Moisture barrier installed [ ] Attic insulation installed: R- [ ] Attic card posted with proof of bags installed [ ] Floor insulation installed: R- [ ] Wall insulation installed: ( ) R-19 ( ) R-21 ( ) R - WIND WASH BARRIERS: [ ] Wind wash barrier installed at attic edge [ ] Overhangs (cantilevered floors and bay windows)have wind wash barriers MECHANICAL: [ ] Ducts running outside conditioned space sealed and insulated with minimum of R-8 [ ] Returns in same space as furnace sealed [ ] Ducts in unheated spaces [ l Water heater has pipe insulation or heat traps installed [ ] Furnace AFUE: [ ] Central Air SEER: OPTIONAL (CATEGORY 1) [ ] All exterior joints in building envelope sealed [ ] Residential mechanical ventilation system installed (Mandatory if one or more item in this column is checked) ----NOTES TO FIELD (Building Department Use Only)------------------------- 0 City of Fridley 6431 University Ave. NE Fridley, MN 554324383 • 763-571-3450 10 -Apr -02 Special Assessment Search And Statement of Char; TO: On all that tract or parcel of land lying and being in Anoka County, Minnesota described as follows to wit: Parcel No: 14-30-24-31-0028 401 63RD AVE Lot: 23, Block: 1, ALICE WALL ADD LEVIED SPECIAL ASSESSMENTS This is to certify that I have examined the records in the office of the Clerk, City of Fridley, Anoka County, Minnesota, and for such search, certify that the following special assessments appear unpaid with respect to the above described tract or parcel of land: Term Certified Initial Interest Remaining Current Current Proiect Number Project Description Type (Yrs) Date Amount Rate Balance Principal Interest 9100-0000-00 00 REG SA(Water/Sewer 3100 15 12/31/1960 $175.48 5.00% $0.00 $0.00 $0.00 6000-1961-00 00 ST 6400 5 10/08/1962 $208.80 6.00% $0.00 $0.00 $0.00 6000-1974-01 00 ST 6400 10 03/17/1975 $792.80 7.50% $0.00 $0.00 $0.00 6000-1978-00 00 ST 3300 10 05/14/1979 $499.94 7.50% $0.00 $0.00 $0.00 6000-1980-00 00 ST 6260 10 05/18/1981 $2,892.00 9.00% $0.00 $0.00 $0.00 3300-1983-00 00 W/S-S 3200 15 10/03/1983 $931.83 9.75% $0.00 $0.00 $0.00 Amount Certified to Anoka County Auditor for Current Year Taxes Is: $0.00 PENDING SPECIAL ASSESSMENTS For the purposes of this document, the City of Fridley has determined that an assessment is considered pending after the City Council passes a resolution ordering the improvement, the approval of plans and the advertising for bids. This is prior to the City Council adopting the final assessment roll. If you seek further information, you should do so upon your own independent inquiry. Any amount given as to pending assessments is informational only and may or may not be the amount ultimately assessed. Term Initial Interest Estimated Proiect Number Proiect Description (Yrs) Year Rate Pending Amt. NONE MISCELLANEOUS FEES Description Status Date Fee Amt. NONE UTILITY CHARGES You shall be responsible to verify the status of any outstanding utility charges. To check utility charges ( water and sewer) contact Fridley Utility Billing Department at 763-572-3529. The records referred to above are public and may be inspected by anyone during regular business hours. The search of these records was made by the undersigned as a public service on request. The undersigned certifies that the above indicated searches were made and are believed to be accurate, however, the undersigned or the City of Fridley does not insure the accuracy of the above statements and does not assume liability for errors and/or omissions. The above figures are good through November 15, 20131 Date Prepared: Wednesday, April 10, 2002 By Page 1 of 1 22 DAV �J C-7 tz•0177 4�t�rn�a�s ,g I I I I ,0 Fi I I o' q� -,r ;,at N O 4 a��� °aSnQH x,2(7 oL! h2Fi 08� • o FiZ I I Li -L rvaW6Cvo f9.") C2 0908 W\ r/ 5 0 c 1�9 - 1017 U LU ' 4,, VrW) "9VId ,UOf4jpPy IfVIA °�'7Itbf 1 -?I,?0'1p, C 0 J-0-7 U I Y I.UI- r-RIULt i iiv6NtG rION Uiv. 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 Eltective un Jan 1, 21102 PLUMBING FIXTURE RATES: NO. 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 Reinspection Fee $47.00/Hr RATE $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE TOTAL -oD 50 $� b JOB ADDRESS "164 —43 A&- 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. S , 20G� Owner All.: rGiia /KK V (/10 v Building Used As Estimated Cost 96yd PERMIT NO. 13q&-3 PLUMBING COMPANY J C -L! i f SIGNED BY_i ►,,��(/�� w✓ TEL NO.���-� �� FAX # 7K— — 0200 4l� Approved By Rough -In Date Final Date COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE THE BELOW MUST BE FILLED IN WHEN -REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED COMMON VFNT, VENT CQNNECTQR AND COMBUSTION AIR VFRIFICATION WhenIn acing an pYisting furamp, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No( ) The venting system is plasticlPVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes( ) No() The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The axkfing rnmhtistonn air is sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When required to rnctall a new _nmeuetrnn airs d will be sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When onctalling a new venting nySttam, 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 : GiYOF FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287 August 30, 2002 Merit Building Co Inc 3029 Coon Rapids Blvd NW #311 Coon Rapids, MN 55433 Re: Final Inspection at 40163 Avenue NE, Fridley Dear Sirs: A final inspection was conducted on August 30, 2002 for the completion of the dwelling at the above address. The inspection noted that the construction was completed according to the approved plan and occupancy of the building is approved. Landscaping needs to be completed on or before October 1, 2002. If you have any questions concerning this matter, please feel free to contact me at 763-572-3603. DAVE JENSEN Builditg Inspector DJ/mh C17? 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 �0_3 kt JOB ADDRESS A10/ A) L Effective On January 1, 2002 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 TOTAL $ 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. $ .50 OWNER bf)N C BUILDING USED AS ZE � ESTIMATED COST CYY) PERMIT NO. /�/3/ DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Unit_ Circle One (Steam) Hot Waterarm Air Trade NameSize No. BTU HP Nit) EDR Fuel Total Connected Load Burner Trade Name t10N e. Size No. BTU HP EDR The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes an rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE (o -1-1 - 0'2- TEL # 7b5 - J 'r 0 Final Date —&-3-6-6-4 r. THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED COMMON VFNT- VENT CONNFCTOR AND COMRIISTION AIR VIFIRIFICATION When re I� a -ing an eYoctinoa f urs ance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes( ) No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes( ) No( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes( ) No( ) The existing c:camb s inn air is sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When required to install a new rnmhi m4inn air. it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When installing a new ventil39egqyStem, 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. YesX 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 -4;07e/Common Vent and Vent Connecter Inform i ion MZ -40 -co _ Appliance #1 Typ BTU Input 2 Fan Assisted or Nat',Fpcbj . 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 C aYISP'i f 1 C Vent Height Cn 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 0�a HEATING CO: n ey-�'a� � A �& Signed By: unc Date 17,6--?-� SHEET METAL SERVICES . PROJECT: 36 N. W. MAlN STREET CLIENT: 8ElHEL, MN 55005 DATE: RESIDENTIAL/LIGHT COMMERCIAL HVAC LOADS DESIGNER: CLIENT INFORMATION: NANL: Dave Miller ADDRESS: CITY, STATE: Fridley Mn. TOTAL BUILDING LOADS: Dave Miller 6/7/2002 Doug ------------------------- __________________ � 8LU6. LUAU AREA ___________________________ SEN. LAT. + SEN. = TOTAL DESCRIPTIONS QUAN ------------------------------------------- LOSS GAIN GAIN GAIN 3-0 WINDOW DBL PANE CLR GLS WOOD FR ---------------------------------- 102 41946 0 3,276 3,276 3-L WINDOW DBL PANE CLR GLS METL FR 60 3,827 U 2,532 2,532 9-G FRENCH DOOR DBL CLR GLS WOOD FR 42 1,929 0 31024 3,024 12-L WALL H-19 + R-8 SHEATHING 2,425 81535 0 2,288 2,288 11-A DOOR METAL FIBERGLASS CORE / 83 31270 0 876 876 lb -H CEILING H-38 INSULATION 1123e 21818 0 11153 11153 11-A 8ASEMT FLOOR 2'OR> BELOW GRADE 11092 2;306 0 0 0 d2 -C SLAB ON GRADE 11/2"EDGE INS(R-8) 34 808 0 0 0 ---------------------------------------------------- SUBTOTALS FOR STRUCTURE:" 51050 __________________________ 28 439 v 0 13 149 v 13 149 , PEOPLE 8 0 0 2,400 21400 APpL1ANLES 0 0 0 1,200 1,200 DUL | WURK {) 0+ 0 0 0 1AFILiHAf1UN W. CFM: 0.0 S. CFM: 0.0 0 0 0 0 0 VENTILATION W.CFM: 114.8 S.CFM: 114.8 ------------------------------------------------------------------------------ 0 117113 21576 2,526 5,102 SENSlBLE GAIN TOTAL .19,275 [EMP. SWING MULTIPLIER X 1.00 BUILDING LOAD TOTALS -------------------------------------------------------- 39,552 a,576 19,275 21,851 SUPPLY CFM AV 20 DEG DT: 761 CFM PER SQUARE FOOT: 0.327 SQUAku FT. OF ROOM AREA: 21324 SQUARE FOOT PER TON: 1,276.280 [U[AL HEA7IN6 REQUIRED WITH OUTSIDE AIR: 39.552 MBH TOTAL COOLING REQUIRED WITH OUTSIDE AIR: 1.821 TONG CALCULATIONS ARE BASED ON 7TH EDITION OF ACCA MANUAL J. ALL COMPUTED RESULTS ARE ESTIMATES AS BUILDING USE AND WEATHER MAY VARY. BE SURE TO SELECT A UNIT THAT MEETS BOTH SENSIBLE AND LATENT'LOADS. STATEMENT OF UNDERSTANDING I, David Miller, 401 63rd Avenue, have read City Code Section 205, Zoning, regarding my use of the property at 40163 d Avenue. I understand that I own a single-family home in a single family -zoning district. I do not own a duplex. I understand the zoning district where my home resides will not accommodate a duplex. Further, I understand that the R-1, Single Family residential Code allows up to two boarders, but that they must share the common areas of the home. I understand this to mean that at no time can locking hardware be installed to separate the upper and lower floors of my single family home. I understand that if I chose to install locking hardware that I have also willfully chosen to violate the City of Fridley single family residential Code requirements and that I will be issued a criminal citation (s) that enable both fine and jail time in accordance with the Criminal Code of the State of Minnesota. Signed: Cpv �' David Miller Owner, 40163 d Avenue Fridley, Minnesota ATTEST: W Julianne M. Tostenson Notary Public Commission /-3/— q 06-S Date: q — `3 -o W 6aaLY NEW (J CITY OF FRIDLEY Effective 1/1/2002 ADDN (J 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: 1/0l 6 ? %,i Ue- " &i Ll lr S 5 Legal Description: XOwner Name & Address: aGV,,,( _5,1 ^ e -U G Tel. # ! 12 - ?AG -,5 Contractor. MN LICENSE # Address: Tet. # LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft Length Width Hgt/Ground Sq. Ft Construction Type: Estimated Cost: $ /010 ds - Driveway Curb Cut Width Needed: FL + 6 Ft = Ft x $ DATE: %-/%- oZ APPLICANT: OR --,,/ -5171,11e,- Tel.# C-12--��6 Call (763) 572.3604 for Permit Fees if mailing In application or Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1200 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: CITY OF FRIDLEY PERMIT NO.: 2004-01516 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 09/01/2004 571-36U4 YAX: ( 763) 5 71-IZ87 ADDRESS 40163 AVE NE PIN 143024310028 LEGAL DESC ALICE WALL ADD LOT 23 BLOCK 1 PERMIT TYPE ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL SAVERS SWITCH. # INSPECTIONS 1 APPLICANT HUNT ELECTRIC CORPORATION 2300 TERRITORIAL RD ST PAUL, MN 55114 - OWNER MILLER DAVID J 401 63RD AVE NE FRIDLEY, MN 55432 ELEC PERMIT FEE - MIN (RESI) 20.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 20.50 PAID WITH CHECK # 117431 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of wort will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 •blip 1111' N W.V. : 40163 AVE NE : 143024310028 : ALICE WALL ADD : LOT 23 BLOCK 1 : BUILDING RESIDENTIAL ADDITION/ALTERATION 571-1287 PERMIT=09/2 9 DATE ISS4 VALUATION : $ 12,000.00 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. FINISH ROOM ABOVE GARAGE. STATE LICENSED CONTRACTOR 1 APPLICANT MERIT BUILDING CO INC (20271430) 2393 COON RAPIDS BLV COON RAPIDS, MN 55433- (763)323-7363 OWNER MILLER DAVID J 401 63RD AVE NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulatin construction or the performance of construction. ApplicanDate Bldg Insp. SEPARATE PERMITS REQUIRED BUILDING PERMIT FEE 209.25 PLAN CHECK FEE 136.01 FIRE SURCHARGE 12.00 STATE SURCHARGE, VALUE 6.00 LICENSE SURCHARGE 5.00 TOTAL 368.26 PAID WITH CHECK # 14212 WORK OTHER THAN DESCRIBED ABOVE. NEW (] CITY OF FRIDLEY Effective 4/1/2004 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION V -P Construction Address: 3? -P & -"0— C415'155- Legal 415'15 Legal Description: Owner Name & Address: -2Av,5 /19_-x./ z Tel. # o (z 986 So 4� Contractor. geJ�+��.+t� � MN LICENSE # I Zv_Z Address: Z •3cr.3 Cans g-APX_PS C_U %�) Tel. # `76 3- 3 Z 3- 73G 3 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 f;z� Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER:f rA�:��rfo f+SoOF--: <! 5 40— Construction Type: 2�F- 6L Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 019/ e -W-1 APPLICANT: ^_x_rT �� p� �'�►��^� 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. CITY USE ONLY - Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 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 [ ] TOTAL $ STIPULATIONS: 2422 Enterprise Drive Mendota Heights, MN 55120 * PIONEER LAND SURVEYORS • CIVIL ENGINEERS (651) 681-1914 FAX: 681-9488 * ene neer ng LAND PLANNERS • LANDSCAPE ARCHITECTS 625 Highway 10 N.E. Blaine, MN 55434 * * * (763) 783-1880 FAX:783-1883 Certificate of Survey for. MERIT BUILDING CO. INC. House Address: 401 63rd Avenue NE �I re 852.11 v fV co Lo(:; M OO BENCHMARK I EXISTING m 0. BS1.87 TOP OF PIPE 851.5 BUILDING g EL 852.07 I ro N8 059'CJV-Ttr- - - - -� TB 921Vx 0.00 "851.7 852.4 850.7 ------------ --------t852.4 Ex Fence c - .. 0„ 7 �� ` 4 18 9 89oZ�j 23 8 851.6 852.3 852.4 852.2 852.4 852, , 10.00 26.00 13.99 851.8 I ad e � 852.0 1 0 22 Fn 1 -DO 852.0 "' �y 0 o TOP OF BLOCK n 852.1 a PROPOSED HOUSE I GARAGE 852.1 5 CRS. BSMT. I ' I N 8 $rJ Y' 10.00 18.33 6.83 31.83 51.9 851.7 x 852.1 852.1 Porc m 52 6 L - i4 DRIVEWAY - 4 BENCHMARK FENCE TOP OF PIPE BENCHMARK I ; m 0. BS1.87 TOP OF PIPE 851.5 1 g EL 852.07 I ro x 851.6 TB 921Vx 851.0 850.7 ZO 851.1 SIDEWALK 850.6 0„ 850.6 4 850.9 60.2 850.4 89oZ�j N89 59-33-W cRs Ctr 63R,D AVENUE 0 000.0 Denotes Emergency Overflow x 000.0 Denotes Existing Elevation x® Denotes Proposed Elevation No+e . s'+- hose Pee P,-eu;oL.S houSQ (ear gro<Jess C-- Lowest Lowest Floor Elevation: S N !i . u CITY,OF FRIDLEY INSPECTION DIV. Effective April 1, 2004 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT R 5 6 9 0 (763) 572-3604, FAX (763) 571-1287 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS �/©f -- �y ~` A/2-- 3 U� fid_ New Fixtures $10.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $10.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $10.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $10.00 and representations stated in this application are true and correct. Catch Basin $10.00 Rain Water Leader $10.00 DATE: �J� , 20a7 Sump/Receiving Tank $10.00 Water Treating Appliance $35.00 OWNER �AtICi A; Water Heater -Electric $35.00 Water Heater - Gas** $35.00 / BUILDING USED AS y'si`c nic Gas Range** $10.00 F J Gas Dryer** $10.00 �; ��, 0®/ ESTIMATED COST &42 PERMIT NO. �{ (� Back Flow Preventer Required ( )Yes () No Type $15.00 � PLUMBING COMPANY ,rAlf' A'4- Reinspection Fee $50.00/Hr SIGNED BY /i, st1��.�s�-�� TEL N0. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance ApprovedBy Rough -In Date Final Date State Surcharge $ .50 S� MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST TOTAL FEE $--3-0 / 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 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 BTU Input venting has been examined and is free from rust, deterioration, obstructions, Appliance #2 Type and is securely supported and firestopped where required. i Yes () No( ) The venting system is plastic/PVC and meets all current codes and manufacturer BTU Input 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 Vent Height include AGA-GAMA Category I Central Furnace Venting Tables for fan Appliance #1 Vent Connector Height assisted and natural draft appliances. Yes () No ( ) Tie existing combustion air is sized and installed to meet the current codes ft Length and manufacturer's specifications. Yes () No( ) When required to install a new combustion air, it will be sized and installed ft Diameter in Type 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 Fumice 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 : CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 VAX: (763) 571-12137 PERMIT N(.::2:00:4-02006) DATE ISSUED: 10/27/2004 ADDRESS : 40163 AVE NE PIN : 143024310028 LEGAL DESC : ALICE WALL ADD : LOT 23 BLOCK 1 PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 0.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL THREE FIXTURES. # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0 # NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS 0 # GAS DRYERS 0 # GAS RANGES 0 # OF NEW FIXTURES 3 VALUE (FOR MINIMUM CALC) 1200 # WATER TRMT APPLIANCES 0 APPLICANT PLBG PERMIT MINIMUM FEE PLBG FIXTURES (NEW OPENINGS) 0.00 30.00 JERRYS PLUMBING INC 13416 HANSON BLVD PLBG FIXTURES (EXIST OPENINGS) 0.00 ANDOVER, MN 55304 WATER TREATMENT APPLIANCE 0.00 (763) 755-4268 WATER HEATER - ELEC 0.00 WATER HEATER - GAS 0.00 GAS RANGE FEE GAS DRYER FEE PLBG REPAIR/ALTERATIONS 0.00 0.00 0.00 OWNER MILLER DAVID J 401 63RD AVE NE STATE SURCHARGE, PLBG FLAT 0.50 FRIDLEY, MN 55432 TOTAL 30.50 PAID WITH CHECK # 22453 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of wort will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law re9Mfffing cpnstrgction or the performance of construction. SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY PERMIT NO.: 2004-02204 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 12/01/2004 572-3604 FAX: (763) 571-1257 ADDRESS : 40163 AVE NE PIN : 143024310028 LEGAL DESC : ALICE WALL ADD LOT 23 BLOCK 1 PERMIT TYPE ELECTRICAL PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADDITION/ALTERATION VALUATION . NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. # INSPECTIONS I APPLICANT MASTER ELECTRIC CO 12467 BOONE AVE S SAVAGE, MN 55378 OWNER MERIT BUILDING CO 401 63RD AVE NE FRIDLEY, MN 55432 STATE SURCHARGE, ELEC FLAT 0.50 ELEC PERMIT FEE - MIN (RESI) 20.00 TOTAL 20.50 PAID WITH CHECK # 073665 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of worl will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date SEPARATE PERMITS REQUIRED FOR WORK U1 HER I HAN Ut bL;RItSCL) AtsVvt;.