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PRE 2010 DOCS*City oFridley, f FMinn. BUILDING PERMIT N® 4 4 3 0 Date: % s.7.`......-•-------- ..._..-�---"�.._®._._.._.._ __-------------------...... Owner: om.----pl.0.e ............ Builder ............................ ?.................. ....................... ® j .....Address ...... .t id-vL_.. Address / qq 1 LO TION OF BUILDING No.....�D. .�(�D. Street . 6._3... 5 --Way. .............. . ...................................-. Part of Lot ...._....-...........- Lot ._ ® .%.[_........ Block....../4........................ ...._.... Addition or Sub -Division ...rX.-.1-(L--1 td..._..�/_�..®......_-------- s/ Corner Lot ... ....... k!!7........... Inside Lot ......_.................._.._. _.. Setback ...........��... ................ Sideyard .........,�� �._�� -----.......---..._........... Sewer Elevation ............1?.. ...... .-.._............................ _...................... Foundation Elevation ........... rJ............3.------................----- DESCRIPTION OF BUILDING To beUsed as:Dp) elliP'j'I f ..�./ , .0.Q(I1e.....��?..�1 �t `Front 4...... Depth ......'1....�.... Height ..... ...1....... Sq. Ft./CU.. �� (O.. Cu. F .3�`�j /�/ F.0._h ... .)2 t*' L. Front ,/..d'�....._... Depth ..... ..�.. Height ....�._9... Sq. Ft. ... .. Cu. F........................ Type of Construction.........i'.-...e........... .. Est. Cost To To be Completed ............ ........ _ ............. _................. In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth din C77"11ance with all provisions of ordinances of the city of Fridley. ,7 ,% Ct In consideration of the payment of a fee of permit is hereby granted to.. ... _............................ .............. ........ _.. .._-._............... ......... ........ .... -........ to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. ii „el -'l Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. 4 ti 4 - 'elj- 7'a CITY OF FRIDLEY INSPECTION DIV, Effective On January 1, 1993 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE JOB ADDRESS The undersigned hareby makes application for a permit for tho work herein Residential Rate TOTAL specified agreeing to do all work In strict accordance with the City Codes and Furnace Shell and Duct Work, Burner — rulings of the Build!ng Division, and hereby declares that all the facts and Also Replacement Furnace 20.00 $ representations stated in this application are true and correct, ®Z. ,1993 Gas Piping (Needed with new furnace) 1$10.00 $ OWNER_L�. Gas Range $ 10,00 $ BUILDING USED AS_®G Gas Dryer $ 10,00 $ _ ESTIMATED COST PERMIT NO. *AIr Conditioning — Ail Sizes $10,00 $ �--• DESCRIPTION OF FURNACE ANg OR SURIJER All 01hers/Repairs.& Afteratlons (LIST ON BACK) 1%<<zf Value of Appliance or Work 4 $ No, of Heating Un I s / Circle One (Steam) (Hot Water) arm Air Trade Nam_ Size No./- Commercial/Industrial BTUIHP EDR ' - 1 % of Value of Appliance or Work $ Fuel Total Connected Load State Surchzrge $ ,50 Burner Trade Name ,Cly Size No. �o BTU ®f,2 HP EDR_ TOTAL FEE $ S E D GWI C K HEATING COMPANY HEATING & AIR CONDITIONING M MINIMUM FEE FOR ANY HEATING/COOLINGPJENTILATION 8910 JWERIWOR &IINNEAPOUB, 5542Q-2853 REFRIGERATIONIAIR CONDITIONING PERMIT' IS 115.00 Signed B el No. 881.= PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 Approved By �-- Rough—In Date Final Date *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner, FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE 4P e - P Coy CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes No ( ) 2.. Is free from rust or deterioration Yes ( No ( ) 3. Has no foreign objects lodged within Yes (1X No ( ) 4. Is securely supported Yes ( No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes No ( ) 6. Has total heating BTU's of All other BTU's TOTAL BTU's Remarks List Alterations Being Done: OCUUMLON HEATING A AIR cnNDITIONING rn 8910 WENTWORTH AVE. SO. � - MINNEAPOLIS, MN 55420-2853 HEATING COMPANY 881.9000 Signed By Date <u� _ li d, `Sx.e �. ..ty: ��L :w'e• -.. ,g.-� � '��u� 'Jtis�.-.ri -.caM---4_'��a . SEDGWICK HEATING & AIR CONDITIONING CO. HEATING JOB NO.7 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 • (612) 881-9000 TEST RECORD ADDRESS CITY r " ° leJ OCCUPANT (JJ A �� 0 OT A, OWNER Wa /7Z SOLD BY �GvOC INSTALLED BY _ S ��S fs. /C �� y MAKE B Ct3a w MODEL 3/ 9 614 Lf/ 0 z i 6 .5 0 SERIAL N0.313 5 14®/ Cl INPUT SO ,000 THERMOSTAT tmhu4C 9a4eir VALVE Bahr t !AQV LIMIT 3 f.. QN LIMIT SETTING 8 o a FAN SETTING :;�/ n+ e J QA -1 PILOT TYPE F ec'td It G IGNITION MODEL 54,Vtn 4 / PILOT TIMING �tr r4,',4 Td n� PRESSURE 3 - S LU/fr PERCENT CO2 S VENT SIZE 41 TYPE OF LINER Veit LINER SIZE -S FILTERS: SIZE /Z6r25 1r I NUMBER WIRING-S-Pcfc. Cy %C ®i TEST TAG LIGHTING INST. V DATt TESTED (� S' 93 INPUT CFH J ® PERCENT OZ (.96 COMPANY TESTING S -C1 Cf (✓f'@ lZ STACK TEMP. y3 d PERCENT CO ® 919 NAME OF TESTER M - �� Gru Iu FORM 235 (REV. 1189) FORM DISTRIBUTION: WHITE COPY - JOB FILE YELLOW COPY CITY SUBJEt7 City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT/e29235 i `COMMUNITY DEVELOPMENT DIV. L_ r � � PROTECTIVE INSPECTION SEC.. (/ CITY HALL FRIDLEY 53432 �j NUMBER REV DATE vAGE OF APPROVED BY 612-571-3450 010415 4/16/99 JOB ADDRESS 90-100 63 1/2 Way NE 1 LEGALLOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 10,11 16 Fridley Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Walter Doelz 2218 W 82 St, Bloomington MN 55431 884-5070 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Dave Lane 33025 Jewel Ct, Chisa o City, MN 55013 257-7200 2081 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Duplex 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Duplex (20 Sq) Tear-off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to 9:00 pm on Saturday; No work on Sunday. Permit Inspection Cards Will Be an To Homeowner To Post SEPARATE PERMITS ARE REOUIRED 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 2 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 $1,714 @ $.86 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. $56.75 Fire C $1.71 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL F -,<� , // $5YA2 SIGNATURE OF CON TRACTOR OR AUTHORIZED AGENT IDATEI P VALIDAT IS IS Y U PER kQ SIGNATURE OF OWNER 16 OWNER BUILDERI IDATE. SF' rSIA E 04/16/1999 11:41 612-257-3681 hFR-1�- ; �:;�•ra Arw ADDN (: ALTER0 LANGE INS. AGENCY IN CITY OF FRILEY SINGLE FAMILY AND DUPLEM R-1 AND R-2 BUILDING PERMI T a' APPLICATION PAGE 02 P.01/04 d F"frective 1/1/99 Constructio M Z Legal Description:............M7Sr�--~--�'__G1_,,,.�,�?..�' ..Owner Name ' Address:Te(..4- 6,, DENY-- ---- Address -03 Attach to this application, a Certificate of Survey of trP. lox, with the proposed construction drawn on it to scale. DESCRI MON OF MPROVEMEN T° MMG AREA,. I�ng� ....._�...._...- Width _... _ _...___ tict�ht ... _. Sq- Pt. � .. GARAGE AMA:. Length .... - , v- .._ _ Width �. � height _..._�_� Sq. -Ft: _ Width _ Iigt/Ground � Ft. DECK AR1�.A.- .-thy .. 4� � _.._._... ;onstruction Type: ,., �-`' � ._ �_._......_._... _.... Estimated Cost. S -. Back) Driveway Curb -Cut Width Necded: _ F<,. + b Ft — Ft x S _.._....... _..__ DATE:..T � I .:._.,,.. .A►PiPLICANT .�� .-- �'�- _ . °i'et. #���' °.?ennit Fee St . Fee Schedule on Reverse Side =ire Surcharge'S__..�......_L�. ,�-.,-- l.n. sm of Permit Valuation {J/Ift9) 'state Surcharge A..._....�..-_ _ _ MOISLOW Valuation ).AC Charge per SAC Uni; .,)cense Surcharge r7 _ _ $5.00 (State Ucemwd ResictertW Contra Fors) 3riveway Escrow S Alt. "A" or AIt. "$" Above ;rasion Control $450.00 Coivservation Flan Review "ark Fee � .,..._. Fee Determined by Engineering ;ewer Main ChargeW .,_..._ ..._„_....__ A're+ementiec;_ssary i a Itrut Nesxsary ; j TOTAL S,,� ' ` , rIPULATIONS : �if o„t �,,,F .> CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK Nt]MRFR OF FIXTURES TO BE INSTALLED ON EACH FLOOR E.ttective On Jan 1, ZU03 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS �G l �/ �! ✓. 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 $ 7.00 The undersigned hereby makes application for a permit for the work herein $ 4.00 specified agreeing to do all work in strict accordance with the city codes $ 5.00 and rulings of the Building Division, and hereby declares that all the facts $ 7.00 and representations stated in this application are true and correct. $ 7.00 $ 7.00 J $ 7.00 $10.00 Owner $ 7.00 $10.00 Building Used As $10.00 J JJ DC) $10.00 Estimated Cost PERMIT NO. / $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge $ .50 TOTAL FEE $ 0.S-6 PLUMBING COMPANY - SIGNED BY TEL NO.-7d- Approved O.-7d- �i✓ (� A roved B v:)—k Rough -In Date Final Date PP Y MINIMUM FEE FOR ANY PLUMBINGIGAS PERMIT IS $20.00 PLUS THE $.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED rQMMQN VFNT, VENT r.QNNFCTQR AND COMB IISTION AIR VFRIFICATION When repla .inn an _xin inaf uri anre, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No ( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturers specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The Pxtina rnmeiistinn air is sized and installed to meet the current codes and manufacturers specifications. Yes( ) No( ) When required to one+all a now rnmhustinn air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When inn allinn a n _w ventingrzyStam, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturers specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) 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