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PRE 2010 DOCSI APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND .AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WARM AIR: Furnace Shell & Duct Work Replacement of Furnace Repairs & Alterations -up to $500.00 Repairs & Alterations each add. $500.00 MECHANNICAL WARM AIR: Furnace Shell & Duct Work to 100,000 BTU each add. 50,000 BTU Replacement of Furnace Repairs & Alterations -up to $500.00 Repairs & Alterations each add. $500.00 SM'.1 OR HOT WATER SYST-%I: RATE TOTAL Job Address $12.00 $ 7.00 $ 7.00 $ Department of Buildings 4.00 $ City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein $12.00 -$ specified agreeing to do all work in strict accordance with the City Codes 4.00 $ and rulings of the Department of Buildings, and hereby declares that all the 7.00 $ facts and representations stated in this application are true and correct. 7.00 $ 4.00 $ Fridley, Minn. OWNER ROUGH INSP. Date FINAL INSP. Date ®� APPROVAL FOR PER41T ±_C�i.l REINSPECTION FEE (.510.003 MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURaLMME KIND OF BUILDING USED AS v TO BE COMPLETED ABOUT —.-.9-o 70 ESTIDSATED COST OLD - NEW BUILDING PERMIT 1.10. PERMIT NO. DESCRIPTION OF FURNACE/BUINER HEATING or POWER PLANTS, Steam, Hot Water, arm Ai No. Trade Name _ xC.L�� Size No. 6:a S P -e AIM Capacity Sq. Ft. EDR BTU HP Total Connected Load Kind of Fuer-= Y� BURNER - Trade Name' Size No. Capacity Sq. Ft. EDR BTU HP Signed By Tel. No.s-,���`S It Boiler & Lines up to 100,000 BTU $12.00 $ each addn. 50,000 BTU 4.00 $ Boiler only up to 100,000 BTU 7.00 $ each addn. 50,000 BTU 6.00 $ OIL BURNER- to 3 gal. per hour $10.00 $ each add. 3 gal. per hour 10.00 $ GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $ (over 199,999 BTU see Fee Schedule) $ GAS FITTING FEES: 1st 3 Fixtures x $ 3.00 $ Additional Fixtures x $ 1.00 $ Gas Range to 199,000 BTU x $10.00 $ AIR CONDITIONING $ FAX HEATING SYSTEMS See Fee Schedule $ VENTILATING SYSTEMS $ ALTERATIONS $ REPAIRS $ State Surcharge $ .50 TOTAL FEE $52 7. -VV ROUGH INSP. Date FINAL INSP. Date ®� APPROVAL FOR PER41T ±_C�i.l REINSPECTION FEE (.510.003 MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURaLMME KIND OF BUILDING USED AS v TO BE COMPLETED ABOUT —.-.9-o 70 ESTIDSATED COST OLD - NEW BUILDING PERMIT 1.10. PERMIT NO. DESCRIPTION OF FURNACE/BUINER HEATING or POWER PLANTS, Steam, Hot Water, arm Ai No. Trade Name _ xC.L�� Size No. 6:a S P -e AIM Capacity Sq. Ft. EDR BTU HP Total Connected Load Kind of Fuer-= Y� BURNER - Trade Name' Size No. Capacity Sq. Ft. EDR BTU HP Signed By Tel. No.s-,���`S It 0 CITY OF FRIDLEY APPLICATION FOR HEATING REPLACEMENT CHIMNEY AND STACK VERIFICATION THIS FORM MUST ACCOMPANY STANDARD APPLICATION FOR HEATING PERMIT FORM. LOCATION �� �� C DATE OWNER ADDRESS ��..�. The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined 2. Is free from rust or deterioration 3. No foreign objects are lodged within 4. That it is securely supported 5. That it meets all current Code requirements for size and total BTU connected 6. Total Heating BTU All Other BTU TOTAL REMARKS HEATING PERMIT # SIGNED �- Licenside by Address 'Telephone�5�- Fridley City License # IIA SUBJECT PER City of Fridle O 5509 AT THE TOP OF THE TWINS BUILDINGPERMIT r RE T NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. y �i / V I i CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 10/9/79 JOB ADDRESS 1086 - 63rd Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 2 Moore Lake highlands 3rd SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Bergstrom 1086 - 63rd Avenue N.E. 571-0076 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Croation Day Ind. Inc. 2200 Cloud Drive, Blaine, MN 755-7573 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. B USE OF BUILDING Residential 7 CLASS OF WORK 1 NEW ❑ ADDITION jl ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 24' x 24' Garage and remodel existing garage to family room 9 CHANGE OF USE FROM TO STWU LATION SN before digging to ggmg 7E� call local U-Ifila5 NONE _ ELECrp SEPERATE PERMITS REQUIRE FOR i�Vl�li�Jf�� HEATING, PLUMBING AND SIGNS 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 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 AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $10,821 $5.41 DOES P ESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT SAC CHARGE OTHER R ISIONS OF ANY OTHER S TE O OCAL L REGULATING CON- UCTIO OR THE CE F ONSTRUC ION. $23.04 -F $36.00 PLAN CHECK FEE TOTAL FEE $64.45 SI T RE OF CON5A�CTiWDR AUTHORIZED AGENT (DATE) WHEN PROPERLY LIDATED THIS IS YOUR PERMIT BLDG INSP IF OA E SIGNATURE OF OWNER IIF OWNER BUILDER) - (DATE) IIA AGREEMENT owner of the property located at IZQ12 ( /x �G have no objection to the i City allowing the construction of a G ;.Q C�'p to be located at without the required certificate of survey that the City ordinarily requires for all new construction. Signature X -3 Address Date _ X9315 CI 4,1 t t , 44-1 rA { a + rlei� - 4 1r �4a 1+, Ali r i y i r fi}- - .... ....�.... Jj- �t ' gr report vo-m-Pre%pyared as eyed P by dfesisiora[ En meetCi . --+ )r Ifte-fMrs of tht State Mim esota.. .... -- -_- © Reg. _ . _ ... .: CI CITY OF FRIDLEY r I APPLICATION FOR RESIDENTIAL BUILDING PERMITS (New, Alterations, Additions; or Repairs) OWNER • < �S�Q � BUILDER: ADDRESS: ADDRESS: f TEL NO:' XPi/— ly)TEL NOi - ou - Construction Location . -STREET NO: / STREET: is zee, LOT: e5 BLOCK: o? ADDITION: AQU,e `S_ C�6�}!1_ �` C� /-K../ L) US -0 Corner Lot: Inside Lot: Setback: Sideyards: Applicant attach to this form two Certificates of .Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION Front: ®1 Depth:._ Height: Squane. Feet: ;Lo Cubic Feet: C #,Ofont: Depth: Height: Square - Feet: Cubic Feet: 48.2.1 Type of Construction: Estimated Cost: $ L lei 6.w�t�0c- (00a6 Zb Be Completed: _ Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE REVERSE SIDE OF SHEET . Mie 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, an-"ereby declares that all the facts and representations stated in this application Xre true and cor;pct. _ DATE:q2k QL Z r' SIGNATURE: Stipulations: S r GSC 23.0 • R�.w►ao� 3�. oo. 0 q:5� -tK 21 S SUBJECT City of Fridley AT THE TOP OF THE TWINS INTER -DEPARTMENT REQUEST PUBLIC WORKS DIVISION CRY HALL FRIDLEY 55432 612-560-3400 No. 3 DATE OF BREAK Ip g TIME A.M. P.M. LOCATION OF BREAK 3 /Lr,%��,,C,?it,CJ REPORTED BY DAMAGE TO PAVING and/or PRIVATE PROPERTY , REPAIRS MADE (Materials, Labor, Equipment) (�+2.��c--w�.co►.. C;� (a/U�,�,c7 --• INSTALLING CONTRACTOR a " TYPE OF MAIN SIZE S JOINT COVER: ft. in. THICKNESS AT POINT OF FAILURE in: NATURE OF BREAK: CIRCUMFERENTIAL ❑ LONGITUDINAL ❑ BOTH ❑ BLOWOUT ❑ JOINT ❑ SPLIT AT CORPORATION ❑ SLEEVE ❑ MISC ❑ APPARENT CAUSE OF BREAK: DEFECTIVE PIPE ❑ CORROSION ❑ DETERIORATION ❑ MISCELLANEOUS (Describe) [3 IMPROPER BEDDING ❑ STREET SURFACE: PAVED UNPAVED ❑ TRAFFIC: HEAVY [:]MEDIUM E] LIGHT` TYPE OF SOIL_Q . ELECTROLYSIS INDICATED( YES ❑ NOJR— CORROSIIDN: OUTSIDE ❑ INSIDE ❑ CONDITIONS FOUND: ROCKS ❑ VOIDS ❑ PROXIMITY TO OTHER UTILITIES DEPTH OF FROST in DEPTH OF SNOW in. ESTIMATED WATER LOSS (hours) TOTAL WATER LOST Gal. INITIAL INSTALLATION DATA: TRENCH PREPARATION: NATIVE MATERIAL ,Oct�r„� ❑ SAND BEDDING ❑ (describe type) �t GRAVEL BEDDING L9 ❑ BACKFILL: NATIVE MATERIAL DESCRIBE �o-.-sY BANK RUN SAND & GRAVEL ❑ GRAVEL ❑ SAND ❑ CRUSHED ROCK ❑ OTHER SETTLEMENT: NATURAL WWATER ❑ COMPACTORS ❑ VIBRATORS Q OTHER (describe) REMARKS_ City of Fridley AT THE TOP Of THE TWINS . WATERMAIN BREAK REPORT . . INTER -DEPARTMENT REQUEST / PUBLIC WORKS DIVISION NO. (f! CETT HALL FRIDLEY 55432 612'560-3450 INUMBER IREV. JDAYE IPAGE OF JAPPROVID BY DATE OF BREAK % !�r) I �. TIME .. 9: (1i . A.M. X P.M. LOCATION OF BREAK O % 2 = G 3 s� REPORTED BY �/u�►c, DAMAGE TO PAVING alpd/or PRIVATE PROPERTY u4•rz REPAIRS .MADE (Materials, Labor, Equipment) LW -4-L 7 vv REPAIR DIFFICULTIES (if any).444 INSTALLING CONTRACTOR E2 r TYPE OF MAIN Lrii SIZE / '� JOINT r COVER:, f t . in. THICKNESS AT POINT OF FAILURE r-- in. NATURE OF BREAK: CIRCUMFERENTIAL ❑ LONGITUDINAL ❑ BOTH ❑ BLOWOUT ❑ JOINT ❑ SPLIT AT CORPORATION ❑ SLEEVE ❑ MISC ❑ APPARENT CAUSE OF BREAK: DEFECTIVE PIPE ❑ CORROSION ❑ DETERIORATION MISCELLANEOUS (Describe) Q IMPROPER BEDDING ❑ STREET SURFACE: PAVED IRUNPAVED ❑ TRAFFIC: HEAVY ❑ MEDIUM ❑ LIGHT TYPE OF SOIL ELECTROLYSIS INDICATED: YES ❑ NOE]' CORROSITN: OUTSIDE ❑ INSIDE ❑ CONDITIONS FOUND: ROCKS ❑ VOIDS ❑ PROXIMITY TO OTHER UTILITIES DEPTH OF FROST in ,DEPTH OF SNOW in. ESTIMATED WATER LOSS 9 / G (hours) TOTAL WATER LOST /57,593. Gal. INITIAL INSTALLATION DATA: TRENCH PREPARATION: NATIVE MATERIAL /2-0-4 �' SAND BEDDING ❑ (describes type) GRAVEL BEDDING ❑ BACKFILL: NATIVE MATERIAL UtDESCRIBE / - LL• BANK RUN SAND & GRAVEL [j GRAVEL ❑ SAND ❑ CRUSHED ROCK ❑P,VIBRATORSOTHER SETTLEMENT: NATURAL E] WATER [j COMPACTORS ❑ OTHER ���cr (describe) 1 SP City of Fridley AT THE TOP OF THE TWINS IKTER-DEPARTMENT REQUEST PUBLIC WORKS DIVISION CITY HALL fRIDLEY 55432 612-560-3450 NUNBER ilif.111iti No.. 7 DATE OF BREAK c� J _ TIME . ' 5.: 3 y A.M.,( P.M. o c LOCATION OF BREAK ,SU - '3 REPORTED BY A DAMAGE TO PAVING apd/or PRIVATE PROPERTY REPAIRS RADE (Materials, Labor, Equipment) REPAIR DIFFICULTIES DIFFICULTIES (if any) ��-a- INSTALLING CONTRACTOR---� TYPE OF MAIN SIZE / JOINT COVER: , �O ft. in. THICKNESS AT POINT OF FAILURE in. NATURE OF BREAK: CIRCtINIE'ERENTIAL ❑ LONGITUDINAL L] BOTH ❑ BLOWOUT ❑ JOINT SPLIT AT CORPORATION ❑ SLEEVE ❑ MIn APPARENT CAUSE OF BREAK: DEFECTIVE PIPE ❑ CORROSION ❑ DETERIORATION MISCELLANEOUS (Describe) ❑ IMPROPER BEDDING H STREET SURFACE: PAVED p❑ UNPAVED ❑ TRAFFIC: HEAVY ❑ MEDIUM ❑ LIGHT ❑ TYPE OF SOIL( ELECTROLYSIS INDICATED: YES ❑ NO CORROSITN: OUTSIDE D N IID CONDITIONS FOUND: ROCKS ❑ VOIDS ❑ PROXIMITY TO OTHER UTILITIES , DEPTH OF FROST in DEPTH OF SNOW in. ESTIMATED WATER LOSS -) g (hours) TOTAL WATER LOST �,-? 0 %93%. O Gal. INITIAL INSTALLATION DATA: TRENCH PREPARATION: NATIVE MATERIAL ❑ SAND BEDDING ❑ (describe type) GRAVEL BEDDING ❑ BACKFILL: NATIVE MATERIAL ® DESCRIBE BANK RUN SAND & GRAVEL ❑ GRAVEL ❑ SANDS ❑ CRUSHED ROCK ❑ OTHER SETTLEMENT: NATURAL ❑ WATER ❑ COMPACTORS ❑ VIBRATORS ❑ OTHER (describe) 'REMARKS nPA � 6 -Y� S- `}r ,a - 9 i( afl — 0 CITY OF FRIDLEY M E M O R A N D U M TO: NASIM QURESHI, CITY MANAGER JOHN FLORA, PUBLIC WORKS DIRECTOR FROM: DENNIS SCHNEIDER, COUNCILMAN WARD 2 SUBJECT: CONTINUING DRAINAGE PROBLEMS DATE: MAY 12, 1986 I have spoken to you on several occasions relative to some of the drainage problems my constituents are having this year. In one case, I have discovered that the drainage problems have related to two broken water mains which were on each side of the constituents home. The case in question is the home of Mrs. Timms at 1072 63rd Avenue. John, as you may recall I spoke to you about her problem about 3 weeks ago. At that time, you had indicated that a small water main leak was found, but that you didn't believe it could have anything to do with Mrs. Timms flooding problems. Subsequently, approximately a week later, I am told that another water main was broken at the pump house directly between her home and Highway #65. Talking with some of the neighbors in the area, they indicated that water was gushinout of a hole in the ground behind the well house. Further, they indicatedg that when the crews came to repair the pipes, whenever they stuck a rod in the ground water just bubbled out. Mrs. Timms contends, and I certainly have to agree with her, that the water and subsequent damage she suffered was a result not of the heavy rains, but of the two broken water mains which in effect surrounded her house. Further more, Mrs. Bergstrom at 1086 63rd Avenue, also suffered water damage from the second water break. She indicates that she called in on April 21st to report that she was gettinwater in her basement and it appeared that there was a broken water main begind the pump house. According to her, City crews did not come out until 4 days later on April 25th. When she spoke to them, I believe on a Thursday, water was beginning to seep in to her basement. The City crews attempted to find the water break, but were unable to locate it. She asked what she should do, and was told we will be back on Monday or Tuesday. Over the weekend, needless to say, her basement on the corner of her house towards the water break became flooded. When she called to see if the water would be shut off, she was told that the water could not be shut off because the business directly behind her needed the water and they had priority over her. �397SOr /v dr( �dV"• 61 Gd "-> V 6-76. 7 d,C,a-/,CJ '-V Finally, on Tuesday of the following week the water was turned off and the break was located. She claims that within 24 hours of the break being repaired all the water in her basement subsided. Clearly I believe both Mrs. Timms and Mrs. Bergstrom have suffered damage as a resu�t of the water main breaks. Whether the City is liable for the breaks I don't know. It does seem to me, that we were quite negligent in not taking corrective action more quickly then the six to seven days that it took to solve the problem. Nasim, can you please tell me what we can do to help these folks who have suffered considerable damage and inconvenience as a result of these breaks. I have suggested to both of them that they make claims against the City through their insurance, and if that fails that they take the City to court through Conciliation Court. Is there something short of that process that I can suggest? In another unrelated situation, but also dealing with drainage, I am having significant problems with three people in the area of 64th and Old Central. Particularly, the Calderon's, Rau's, and the Nelson's. All three of the eopple clalm that this year their water problems have been exasperated by the illing of the lot on Mississippi Street where the old abandoned house stood that the Fire Department burned down a couple of years ago. Apparently this lot has acted as an informal holding pond and now that it is being filled, the water which had not affected the Kau's or the Nelson's before is now causing them significant problems. We have cleaned the culvert out for Mr. Calderon and that has helped somewhat, but there is still a significant problem in the area. Could you please tell me what engineering options exist, hopefully not major pprojjects, but in any event what can we do to solve the problem that these Folks now have? I believe that Mr. Nelson will be present at the Council meeting on May 19th to indicate his concern and make a statement in to the record at the open forum. I would appreciate your attention to both of these situations. I know water problems are difficult, but I am looking to you as experts to at least indicate what options there may be and what information I can give back to my constituents. Thank you for your help, we are looking forward to your prompt reply. Sincerely, Dennis Schneider Councilman, Ward 2 May 15, 1986 John Flora Public Works Division City of Fridley 6431 University Ave. NE Fridley, Mn. 55432 Mr. Flora: Re: J. W. Bergstrom Home 1086 63rd Ave. NE On or about April 91 1986 we noticed water seeping into NW corner of our basement. We never have water in our basement as we have proper drainage sloping from the foundation and eave troughs on our home. In watching this it gradually started to increase and by April 21st we noticed that the City was checking as they were looking for a leaky pipe between our home and the home at 1072 -63rd Ave. N.E owned by Mary Timms who by this time also had a basement full of water. On Friday, April 25th I spoke with the City workers and they in- formed me obviously there was a leak or more than one leak as the water was coming up out of the ground already but they could not find the leak: By this time the West half of our basement was covered with water and it continued to spread throughout the basement. The City workers said they'd have to wait until the following week in which to turn the water off and check for this leak because two business places, Pulanski's and Country Club Market behind our home needed water for their business. It didn't seem to make any difference that our basement was being flooded. I find this very hard to understand. Tuesday, April 29th, the water was shut off and they said they found the leak but the water was coming into our basement con- tinually on the West end now and covering the entire lower level of our basement. So apparently they did not find the leak or stop the water problem because on Sunday, May 4th in walking to the Country Club Market we noticed water coming out of the ground, yet, and in a different location now behind the pump house on the West side of Mary Timm's home. By Tuesday, May 6th the City started digging again and according to a gentlemen by the name of Rusty, who is apparently the foreman of the Water Works said they found another leak and the water should now be going down and I would soon see dust. Contrary to that our basement due to the saturation of the ground took some time to clear and it's just now starting to slow down because of the pipe breaking in these two places and saturating the ground and it naturally sought it's easiest route and that was to come up between the basement floor and our foundation. May 15, 1986 Page 2 This is not the first time that this has happened as it did happen approximately 5 years ago. We had the same situation due to a cracked pipe being put into the ground only to cause water problems in my basement and finally after almost a week the cracked pipe had to be replaced and I was never reimbursed for this water problem of which Rusty from the Water Works is fully aware of. This will clearly give you the reason that we -feel that the City of Fridley does owe us restitution for the damage,to our lower level of our home not to mention the labor and the work involved. We had new carpet put throughout the lower level of our home in the family room area in October of 1984. The tiles will definitely all have to be replaced and there is extensive damage to the Knotty Cedar. We've had to move all the furniture from the basement except the piano and bar which are on blocks now. We've put in countless hours of vacuuming and mopping in the laundry room and workshop areas. In accessing the damages we found the cost of repairs and replacements would come to: 52 yds. of Carpet @ $14 per yd. $888 plus installation Tiles - 480 sq. ft. plus installation $240 4 gal glue 60 Paint for Walls $ 40 4" Floor base molding (168 ft.) + glue $144 $1,372 - We will access the damage to the Cedar rather than replace it due to the extent of labor. Your prompt attention to this would certainly make things more livable in our home if we know that this problem has been taken care of, number one and number two, that we would have recovery from the City of Fridley for their negligence and when they were aware of the problem totally left it go because of the businesses needing water. I think an emergency situation was at hand and it was a poor decision on the City of Fridley's part to leave the water go for several days full well knowing the problems it was causing in two of the local homes and the pipes apparently run directly in between these two homes. Th,4r9c, you�� J�6hn W. & Sylvia B. Bergkirom Ph: 571-0076 (home) & 781-7425 (Wk., 'Sylvia, M,W,Fri) P.S. On Saturday, May 10th, Dennis Schneider, Councilman was out to our home to access the situation and is aware of the problem. z' CITY OF FRIDLEY INSPECTION DIV. Effective On March 1, 1996 6431 university Ave NE Fridley, MN 55432 APPUCATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604. REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace) Gas Range Gas Dryer *Air Conditioning - Ail Sizes All Others/Repairs & Alterations (UST ON BACK) 1% of Value of Appliance or Work Commercial/industrial 1.25% of Value of Appliance or Work Rate TOTAL $ 30.00 $ 3o, 0Z $ 10.00 k- $10.00 $10.00 $ $ 10.00 $ $ 25.00 $ t s-- 0 State Surcharge TOTAL FEE JOBADDRESS I D6 6 6 IV -4 34),v- N. - 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 representatiorm stated in this application are true and correct. �_J okn BUILDING USED AS � ESTIMATED CO005500.0D PERMIT NO. DESCRIPTION QF FURK„CCEE AND QR -BURNER $ No. of Heating Units � Circle One (Steam) (Hot Water) Trade NameRy�--77 _pSize No. -I S 6 0 BTU _'1 SE o= HP EDR $ Fuel Total Connected Load $ .50 Burner Trade Name Size No. BTU liP EDR WNPAWN—FE9 FOR ANY HEATINW9Q_(OLI1YG/IfEN1IIATION RRIGERATION/ JALR CONDITIONING PERMIT IS $25 DO PLUS THE $ 50 STATE SURCHARGE REINSPECTION FEE $42.0Q/Hr 'Air Conditioners can not be placed in a side yard wRhout written permission from adjoining property owner, 1996 HEATING COMPANY C r� Signod No. r/b -454 ST- Approved By Rough -in Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE SO •d -Idlol r �DBCo �O'J�- 4V L l t, `� Ciit1104ff AM S"f"ACIK VERIFICATiOl1T The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined 2. Is free from rust or deterioration 3. Has no foreign objects lodged within 4. Is securely supported 5. Meets all current Code requirements for size and total BTU's connected / 6 Has total heating BTU's of G/G 000 All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater 8. Has combustion air been provided for water heater Remarks: List ALTERATIONS Being Done: r�°KZ HEATING CO: Signed By: Date: Yes?? No ( ) Yes N'No ( ) Yes K No ( ) Yes KNo ( ) Yes T J No ( ) Cess ��r Yes ( No ( ) Yes No ( ) s 0 I., Address 1 1-' Installed By Electrical Work TYPE OF HEAT: GAS DESIGN HOUSE HEATING TEST RECORD City /=� r��.� Owner er-- ' Date Installed' GA FA HW STEAK SPACE HTR UNIT HTR OTHER CONTROLS Make ��"P ' Thermostat 7 9 Model 4-'M w7Valve �� s ���.,A-? 9,. Serial No. -7 r 7 7 41-2 -2 Limit Input °aT Limit Setting 90 Vent Size ---) Fan Setting Rind of Liner Pilot Type����9.-� Size of Liner Pilot Bake Filters: Size Number Pilot. Model Chimney Location: Inside Pilot Timing Outside L.W. Cut Off Chimney Construction i, Pressure 2. '® "e--- %COZ � Input CFH I? $- % Oz, Stack Temp /®�,®�' XCO Tested By: Erickson lumb g Heating Cooling, Inc. Name of Tester Date Tested�� i", SUBJECT IT NO. City of Fridley 2 8674AT THE TOP OF THE TWINS BUILDING P E R M I T Ir ,, 572-3601 COMMUNITY DEVELOPMENT DIV. `y _____ r PROTECTIVE INSPECTION SEC. r 1 ; NUMBERNEV GATE PAGE OF APPROVED BY CITY HALL FRIDLEV 55432 612-571-3450 910-F15 11/30/98 JOB ADDRESS 1086 63rd A!::1 1 LEGAL LOT N0. BLO TRACT OR ADDITION SEE ATTACHED DESCR. 5 M _ SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Bergstrom - 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO New Haven Const.Co566-5225 20077950 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 O NEW O ADDITION ❑ ALTERATION �c REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house (9 Sq) Tear -off 9 CHANGEOFUSEFROM 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 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 771 rj DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TME PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $29.25 Fire S PLAN CHECK FEE TOTAL FEE SIGNATURE OF CON'RACTOR OR AUTHORIZED AGE NT (DATE, EN OP ALIDATED H IS YOUR PERMIT S,GNATURE OF OWNERI,F OWNER BUILDER, I ATE,G 'NSF' 621v of, GATE Ndip 30 98 11:03a Kerri 566-7183 NEW [ ADDN [ ALTER [� CITY OF FRIIH.EY SINGLE FAMILY AND DM-EXES R-1 AND R-3 BUILDING PERMIT APPLICATION ConstntctionAddress: Legal Description: p.4 Effective 2/1/98 Owner Name &Address: Contractor:�Ptic/�i Tei. # 57/— D [7 Address: MN LICENSE At ao e 7.7 9,S--, Attach to this application, a Certificate of Survey of the rel. # lot , with the proposed construction drawn on it to scale. IDESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width GARAGE AREA: Length Height Sq. Ft. DICs X ARRA: Length Width _Height Sq. F Width t. OTHER: --� RX/Ground Sq. Ft. Construction Type: ��,Qc2uo F Estimated Cost: Driveway Curb Cut Width Needed:(Fee Schedule on Back) Ft. + 6 Ft = Ft x $ $ DATE: APPLIC Tel. #SSG -J--9-k3- USE siNLY MY Permit Fee Fire Surcharge Fee schedule on Reverse Side State Surcharge $ 7 Sb .001 of Permit Valuation (1/10th%) SAC Charge $ $.501$1,0Q0 Valuation License Surchar a 8 S ��e $1000 Per SAC Unit $5 Driveway Escrow $ �.00 State Licensed Residential Contractors) Erosion Control $ Alt. "A" or Alt. "B" Abode Palk Fee $ $450.00 Conservation Plan Review -. Sewer Main Charge $ Fee Determined by Engineering Agreement Necessary. [) Not Necessary [ 1 TOTAL STIPULATIONS: CINOF FRIDLEY ,FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (612) 571-3450 - FAX (612) 571-1287 March 4, 1999 John Bergstrom 1086 63`d Avenue NE Fridley, Mn 55432 Re: Final plumbing inspection at 1086 631 Avenue NE Contractor: Mr. Rooter Of Anoka County Dear Mr. Bergstrom: A plumbing permit was issued on Jan. 7, 1998 for the property located at 1086 63rd Avenue NE for a gas water heater installation. According to Section 30.5(a) of the 1991 Uniform Plumbing Code a final inspection shall be performed on plumbing systems. As of this date no inspection has been called for. You will be given thirty (30) days from receipt of this notice to respond. If we do not hear from you, we will expire the permit and any inspections on this installation will require a new permit. Any questions can be addressed to myself at (612) 572-3603. Sincerely, A, 41, & Bary Riesch Building Inspector CITY OF FRIDLEY INSPECTION DIV. 643'1 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLU MAAW W, IV.: = M A1C =YM lace •rn cc r Effective On January 1, 1997 FITTING PERMIT i �.• Water>, .•<{:<-<>-, RATE TOTAL �::- :> d.{;�q,,�,:. Wash M �Dn��//nTcR- .Auto. rjv{5•Si. :Gaa��'::.;�: Gas Mis�:•�` Water Heater Stories Cfosefi Urinal :,:v,. T (i ' ':Ki Shower ;Sin...;:: Tray .y.•:OG�'•:•J. FF-%:{:: :::1;�:.;y4;.?:� ;: $10.00 ::::i?••:4i ,Y 4: . $ 7.00 Water Heater — Gas" �— $10.00 Gas Range'" $10.00 Gas Dryer** :Patf . Washer 4ppf� x Range :i Gas Etec Basement :.;,. <:�;.- •:4--: poi.,.. .. tiv {%r• •� < <` •%:iv,4:,{�; .:T;:r<:�:: 'C^:•..i :4�;?Y: Y::M�i:�i.,'•- Floor 1 :":i'::: <,; i}i{r-,'?: `•'l.•.:.} .; :..:>: , : t>::.:>..: Floor 2 .•:•'`-.'•�-' i'. .. A; :'�4:::'ti\::v Floor 3::...,•VnM :::iii::., `;iX:? -•i• is?i.:�..L'yn{.'IS:•::: '.:�-%?i.;:::•:::w�:; Floor 4 i>i'b'si'. :?iJ:::iih:• w.�.. •v::. ;'nom,.::... •:::d :Y: .... :...... �-:�.�+,.ho-: .. 5:.:..: is -::ate.-:}:i::•i:: .•S .d _M:.yS.;y. PLUMBING FIXTURE RATES: NO. RATE TOTAL New Foctures $ 7.00 Old Opening. New Fixture $ 4.00 Beer Dispenser S5.00 Blow Off Basin $ 7.00 Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Recd*Mng Tank 37.00 Water Treating Appliance $10.00 Water Heater —Electric $ 7.00 Water Heater — Gas" �— $10.00 Gas Range'" $10.00 Gas Dryer** $10.00 Back Flow Preventer Required ( )Yes () No Type $15.00 Reinspection Fee $42.00/Hr ALL OTHERS AND/Ori REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance r moi` State Surcharge $ x.510 TOTAL FEE $ . r JOB ADD - ��� . �®" -t�,�.0e a The un am makes application for a perml for the work herein spPcffil to do all work in strict accordance with the city codes and rutin Building Division. and hereby declares that all the facts andre stated In this application are true and correct . 1998 Owner 1A Building Estim PERMIT NO. 0 1-16 PLUMS ANY_ MR. ROOTER OF ANOKA C oliNTy'� 6250 Industry Ave. N. #114 SIGNED 3& N0. 421-6140 421 -6198 -FAX Approv ough—In Date Final Date MINI MU FOR ANY PLUMBINGIGAS PERMIT IS $20.00 "COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) 6—A MINIMUM SIZE 9 SO INCHES. CITY OF FRIDLEY INSPECTION DIV. ✓ A 6431 University Ave NE /I q Fridley, MN 55432 / b 572-3604 ff: Effective On January 1, 1998 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT - _ rjFACH_ r <. MIs- ;Water Heater TElec /6 94:- 613 /�p c>L jti'E—) J 6 fq tiy 1-71 '56o SUBJECT PE N City of Fridley 3 3 9 4 AT THE TOP OF THE TWINS BUILDING PERMIT COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 NUMBER REV DATEPAGE OF APPROVED BY j CITY HALL FRIOLEY 35132 763-571-3450 910-F15 3/24/03 JOB ADDRESS 1086 63 Avenue NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED OESCR. 5 2 1 Moore Lake Highlands 3rd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Wally/Sylvia Bergtrom 1086 63 Avenue NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Quarve Contracting 8427 Center Drive NE, Spring Lake Park, MN 55432 6016 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 763-786-7746 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION #7 REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Install soffit & fascia 9 CHANGE OF USE FROM TO STIPULATIONS Install soffit ventilation to meet the State Building Code. 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 I HEREBY CERTIFY THAT 1 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 $29100 $1'05 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. $83.25 Fire SC $2.10 S TION OR THE P RFORMA CE F CONSTRUCTION PLAN CHECK FEE TOTAL FEE Licen a SC $5.00 $91.40 SIGNATURE OF CON-RACTOR OR AUTHORIZED AGENT DATEi EN PROPERLY VALIDATED THIS IS YOU PERMI 03 _ I � S-GNATURE OF OWNER,.F OWNER BUILDER, IDATE, LOG �NSo FIA Tt NEW [ ] CITY OF FRIDLEY Effective 1/1/2003 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 Construction Address: In%a (4�-3 ,1 Legal Description: Owner Name & ddress:l l UV ,nom Tel. # Contractor: h MN LICENSE # ®I Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: 's +-I - Construction Type: k Ire Estimated Cost: S1k. iters-) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: i% APPLICANT: Q 1 �C. Tel. # 6 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 - TOTAL $ G°�,� 63. Permit Fee $Fee Schedule on Reverse Side Fire Surcharge $ /0 .001 of Permit Valuation (1/10th%) State Surcharge $ Sc_ $.50/$1,000 Valuation SAC Charge $ $1275 per SAC Unit License Surcharge $ Z-,00 $5.00 (State Licensed Residential Contractors) Curb Cut 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 $ G°�,� CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 FAX: (763) 571-1287 PERMIT NO.: 2004-00470 DATE ISSUED: 04/09/2004 ADDRESS : 1086 63RD AVE NE PIN : 133024340012 LEGAL DESC : MOORE LAKE HIGHLANDS 3RD LOT 5 BLOCK 2 PERMIT TYPE PLUMBING PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADDITION/ALTERATION VALUATION $ 0.00 # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 300 # NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS 0 # GAS DRYERS 0 # GAS RANGES 0 # OF NEW FIXTURES 0 # WATER TRMT APPLIANCES I APPLICANT PLBG PERMIT MINIMUM FEE PLBG FIXTURES (NEW OPENINGS) 0.00 0.00 SHILOAH WATER CO 7319 166 AVE NW PLBG FIXTURES (EXIST OPENINGS) 0.00 RAMSEY, MN 55303- WATER TREATMENT APPLIANCE 35.00 (763) 753-9244 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 BERGSTROM JOHN W & SYLVIA B 1086 63RD AVE NE STATE SURCHARGE, PLBG FLAT 0.50 FRIDLEY, MN 55432 TOTAL 35.50 PAID WITH CHECK # 9789 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 regulating construction or the performance of construction. Bldg SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY INSPECTION DIV. Effective April 1, 2004 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT (763) 572-3604, FAX (763) 571-1287 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR jog-& " X03 rA� PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 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:✓- -.20 Sump/Receiving Tank $10.00 Water Treating Appliance $35.00 OWNER Water Heater -Electric $35.00 Water Heater - Gas** $35.00 BUILDING USED AS 112 AAAW w, Gas Range** $10.00 A66q' ' Gas Dryer** $10.00 ESTIMATED COST PERMIT NO. Back Flow Preventer Required ( )Yes () No Type $15.00 PLUMBING COMPANY g64-0� Reinspection Fee $50.00/Hr SIGNED BY TEL N0. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance Approved By Rough -In Date Final Date State Surcharge $ MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST TOTAL FEE $S� 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 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 verges 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 verges 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: