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PRE 2010 DOCS01 SUBJECT P City of Fridley ® 12211 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 _ � �4 "1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 6/29/73 JOB ADDRESS 1040 - 64th Avenue N.E. 1 LEGAL LOT N0. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 2 Moore ffi Lake highlands SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Mr. H. E. Walton 1040 - 64th Avenue N.E. 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 IN ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct 20' x 24' Addition to Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS PERNUTS REQUITtED FOR WOO, SEpERATE AND SIGNS - HEATING, RLU. ABIMG TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, Wood Frame VENTILATING OR AIR CONDITIONING. 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 R-1 4$O 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 $6,854.40 3.43 WITH WHETHER SPECIFIED HERE 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 TATE OR LOCAL LAW REGULATING CON- $18.00 STRUCTION OR THE PERFOR ANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEF 821."!+3 n SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) VALIDD IS S Y R PERMIT !2='- BLDG INSP DATE SIGNATUREOF OWNER (IF OWNER BUILDERI (DATE) 01 APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME : , A LTB /1/ BUILDER: ADDRESS: _/& `�® - c.� S� — �� '27 e ADDRESS NO :. i ® -7/ Q STREET lr LOT' —3 BLOCK: - ADDITION CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: 1/ c' , Front • i ® —Depth: 42 -c/ Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: Estimated Cost: $ To Be Completed: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in sttict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct, 0DATE: -9/SIGNATURE: (See Reverse Side For Additional Information.) ' o �Q �ltt •- .q�ep f'rA^t-�v � . -. a-+ �j p4k�.r..-"• �.:F•. I "Tailcilco �fp 5�..�.» �! a q., d gt �. J�Os FI'.er @'J 's3 ��'rsCa��cv ii as.o--oea w.d>��GS Gcw�a�s�'.rc� w9i►z�u�p ��.dCdG ulr �o.tit•Od'ati� LOG.rrt:c�Wuirr6b�G1 f¢'as►ia9 g • • PARTIAL RATE SCHEDULE GRAVITI! WARM AIR: �°ti r..i M TOTAL Fsrnxce Si 01 epi rNd Work $10.00 $ Replacement of Furnare 6.00 $ P.epai-s & Atterat.ons-- up to $500.00 600 $ Repairs do Alterations each add. 3500.00 300 $ 1! XCIL WARM AM r rnacr Shell & Duct Wnrit to 129,000 BTU .11000 $ each mdd. 60,000 BTU RepUAce-melt of Flarnace 6.00 3 Repairs & Alterations. --up to $500.00 6.00 $ Repairs & Alterations each add. $500.00 3.00 $ STEAM as HOT WATER SYSTEM Purrace Shell & Unes--to 400 sq. ft ?.DR Stettm $10.00 •3 ' Furnace Shi-A do Line ---to 640 sq ft. EDR Hot Water 1000 S. Each add 200 sq. ft EDR Steam 30n $ Each add. 320 sq. 1t EDR Hot Water 3.00 $ OIL BURNZE-to 3 gal. per hour 6.00 $ over 3 gal. per hour -.See Fee Schedule GAS BURNER Cup to LS9.000 BTU) over 133.000 BTU Soo Foo Schodulo GAS FITTING .-EE.S. Ito RATE TOTAL X$ ZOO S ` U U x .78 $-_. XS 5.00 S State Surcharge .50 C Y:oe Fee Sudo TOTAL P=' 2/ S Cr 5.00 $ 5', v o Ist 3 fixtures Additional Fixtures Gas Range to 199,0W AIR•C0X MORIIIG` FAN H=-.L%G ST37=2 VEN7"n.F.TIZG BT s—C w r .L bapt. of Blrlga. Phone s0-uso City of Fridley: The undersigned hereby makes application foi• a permit for the work here& specified agr.-ing to do all work in strict accordance with the City Ordinancer- and re,ling of the Department of Buildings, and hereby declares that all the fACUM and repl,spntatiuns stated in this appbcauan are true and correct. Fridley, (.sumer Kind of Building Used a• It To be completed about . Estimared Cost; $ / Old -New. Building Permit No. _ Permit No. >Q'.�.o"Cc+3xTIGIST or Wo3z HEATING or POWER PLANT`.' Steaas, F.ot Water, Warm Air -Pio Trade Name Sire Pio G G Capacity—_-- — Sq. FL E.D.R BTU E.P Total Connected iced. Rfad of Fuel BURNER - TYmdx Nae Sire Ido Capacity 3q. IPL E.DA vM SP: 3iy �o - t=AIX$.-oraaj City d Fridloy Application for Plumbing C.nd GcM Fax�onI Pe M. -Tit' Dept: of Bldpa. Phone 560-3430 DESCRIPTION OF W0171 Locatioa Number: Kind and LocrKon of Fixtures _.� • Futuro. Ccnnoct5cu Cq;,aninq% * Haw Fixture, Old Openings Secror 0 Ccc:.pool C] PARTIAL RATE SCHEDULE LQ:+lSING FIXTURE RATES: NO. RATE TOTAL � � G Number Fixtures ................ _ - x $2.00. $ Future Fixture Opening ........... x $1.50 S -• New Fixture Old Opening.....:.... x $1.50 WATM MTR, w V t~ � Water Heater 'Up to 99,000 BTU) • • • • x $3.00 $ New Ground Run 013 Bldg....:.... x ;3.25 •p N Z v iectrlk Plater Hastar..... 1 ..... 0 - . s $2.00 y g • Y GAS MC. Additional Fixtures ............... x $ .75 $ Gas Range to 199.000 BTU ...... ......---- x $5.00 6 !st ind 3rd • Futuro. Ccnnoct5cu Cq;,aninq% * Haw Fixture, Old Openings Secror 0 Ccc:.pool C] PARTIAL RATE SCHEDULE LQ:+lSING FIXTURE RATES: NO. RATE TOTAL � � G Number Fixtures ................ _ - x $2.00. $ Future Fixture Opening ........... x $1.50 S -• New Fixture Old Opening.....:.... x $1.50 Catch Basin ....... . .......#-o%- x $3.25 $ Water Heater 'Up to 99,000 BTU) • • • • x $3.00 $ New Ground Run 013 Bldg....:.... x ;3.25 $ iectrlk Plater Hastar..... 1 ..... 0 - . s $2.00 $ r1.S FITTING FEES: NO. RATE TOTAL Ist3Fixtures •••••••••••••••••• x$2.00 b . Additional Fixtures ............... x $ .75 $ Gas Range to 199.000 BTU ...... ......---- x $5.00 6 City of Fridley:. The undersigned hereby makes appUcation for a .permit for the- work her el specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buil ngs; and hereby declares -that all the fad and representations stated in this application are true and correct' Fridley Minn 19— Ow n e r 9_Owner Kind of Building Used as To be completed about — Estimated Cost. $_ -- - / Old-= ew. Building Permit No. Perait No.Signed aj By - Business Phone No - - — ROUGH EMPAIRS rk ALTERATIONS—Refer to Code .50 State Surdharge . De :cription ................ c ........ ,.............. $ ,� TOTAL FEE �— SUBJECT PERMIT NO. City of Fridley 2 0 4 3 5 AT THE TOP OF THE TWINS BUILDING P E R M I T i � EIPT N � • COMMUNITY DEVELOPMENT DIV. ,.------; PROTECTIVE INSPECTION SEC. r � � NUMBER REV DATE PAGE OF APPROVED BY �'--1 CITY HALL FRIDLEY 55432 �----ilk" 612-571-3450 910-F15 6/21/90 JOB ADDRESS 1040 - 64th Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 2 1 Moore Lake Highlands 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Harwood/Grace Walton 1040 - 64th Avenue N.E. 571-2835 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 .0 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE . 8 DESCRIBE WORK Construct a 16' x 1017" and a 4' x 5' Deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. Provide frost footings, WARNING Before digging call for all o ility. location 454-0002 REQUIRED BY LAW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 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 VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1 300 $.65 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT r PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $29.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $29.65 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WH PROPS ID TED HIS IS YOUR PERMIT DG NSP DATE S��NATURE OF OWNER IIF OWNER BUILDERI IDATEI NEW [ ] Effective 1/1/90 ADEN [ ] R-1 AND R-2 ALTER [ ] Building Permit Application Construction Address: /e> 40 4,14 - d aVF' ALL Legal Description: Owner Name & Address: Algg 4 -reb Tel da Contractor: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVIM AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width O- ` Hgt/Grp Sq. Ft. /to d OMM. J -r y, I ?6v 7.71 � `lout 6 Corner Lot [ ] Inside lot,[ ] Ft. Yd Setback Type of Construction: _ � %� ('tk)o A Approx. Completion Date: Side Yard Setbacks Estimated Cost: $. IOU a Proposed Driveway Width If New Opening Is Desired: Ft. $ $ Width + 6' See. Back Page DATE: APPLICANT: Tel. # CITY USE COY Permit Fee $ ,, Fee Schedule on Reverse Side State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $600 per SAC Unit Driveway Escrow $ Alt. "A" or Alt. "B" Above Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL l -3p • q W %, l� Land Planning Land Surveying Soils Testing Civil Engineering Municipal Engineering Se � 1 / 6875 Highway No -65 N.E. {�,�1/e'r%If � � f Minneapolis, (/ lih1 'r'/b �• Minn. 55432 / (� Telephone 784-6066 Engineers Area Code 612 & Surveyors Certificate of Survey for G4'ra AvEwE N,E, 90.00 211 "59.36 M ...... I'�2 dory Frame ;,ucco 1040 X1.60 9, o AA 20.0 n- , 23.3' c4. r aQ` I zn L9 r:!,- W. ry I n NnAs iron tY)0nWmen1 JUNE aAI3 LOT -3 . BLOC�2- LAKE HIGHLANDS. ADDITION r.U�Yr}y �' Or4ina P Ecrsernenll - - -- �, ' 90.0o AnakQ County PLANTING GOULEARD I hereby certify that this is a true and correct representation of a survey of the boundaries of the above described land, and of the location of all buildings, thereon, and all visible encroachments, if tiny, from or on said land. As surveyed by me this ' day of, A. D. 19 -- SUBURBAN ENGINEERING, INC. -t - panssT uaaq spq Aousdnaap 3o a�>3az3��sa0 s TTjun paTdnoao ao pasn aq lou TTugs ainjonals PTRs PUB !panssl uaaq sviT 1T=ad BuTpjjnq u ijozgM 101 aznjonals A= jo Aauvdnaao ao asn aga of ioTad sAsp (0I) ual apmu aq ?.Trigg Aauvdnaap 3:, a�E9��axa0 B aoj uoT:jt;aFTddy I , � L_ _ r I , I I I ' _ --+----�•-tom; � - � � � _ .1� I�,�I I � I � - - (�� +- -- - I I ' i_ , I I, , H7 --- , -+ ��-� , --- }-- ---- +--- -- - - - - - , -- -44 - - I --{--- - -� I , I I I I -- - � — SUBJECT PERMIT NO. City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT 23736 Ir TN �4 COMMUNITY DEVELOPMENT DIV. L-------- PROTECTIVE INSPECTION SEC. r53 �'-'1 CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY _A", �'' 612-571-3450 910-F15 JOB ADDRESS 1040 64thAVE NE T LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 2 MOORE LAKE HIGHLANDS 2ND ADDITION SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE 1040 GRACE WALTON 1040 64th AVE FRIDLEY MN 55432 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO VERN'S COMPLET HOME SERVICES 12641 63rd AVE N MAPLE GROVE MN 55369 559-9332 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 _II REPAIR ❑ MOVE ❑ REMOVE XR 8 DESCRIBE WORK REROOF TEAR -OFF (14Sq) 9 CHANGE OF USE FROM TO STIPULATIONS UNDERLAYMENT MUST COMPLY WITH THE STATE BUILDING CODE. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITSOFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ISTALLS I GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED 1120.00 .56 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS PF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 40.25 FIRE SC 1.12 STRUCTION R THE PERFORMA OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE _ LICENSE SC 5.00 46.93 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROP] L'YVe'LIDATED THIS IS YOUR PERMIT LDG )NSP DATE SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI a NEW [ ] ADDN [ ] ALTER [] Construction Address: Legal Description: Owner Name & Address: Contractor: Address: 61 ! CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Tel. # Effective 8/1/95 LICENSE # uTel. # 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 GARAGE AREA: Length Width Height DECK AREA: Length Width Hgt/Ground OTHER: ` 1 -CcPo` -, v7�- i^e" .�` J Corner Lot [ ] Inside Lot [ ] Type of Construction: Approx. Completion Date: _ Ft. Yd Setback Sq. Ft. Sq. Ft. Sq. Ft. Side Yard Setbacks Estimated Cost: $ 1r to (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: -2� Tel. #—,6,�Iol Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY $ Li o, -Z5 Fee Schedule on Reverse Side $ ` , 1 ;?, .001 of Permit Valuation (1/10th%) $( $.50/$1,000 Valuation $ $850 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 [ ] SUBJECT . City of Fridley 1rAT E28 THE TOP OF THE TWINS BX ILDING PERMIT O. COMMUNITY DEVELOPMENT DIV. r � PROTECTIVE INSPECTION SEC. � 1 � NUMBER REV DATE PAGE OF APPROVED By i CITY HALL FRIDLEY 55432 612-571-3450 910-Ft5 11/25/98 JOB ADDRESS 1040 64th Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DEscR. 3 2 1 Moore Lake Highlands 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Cheryl Whitney571-28%35 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Renewal by Andersen 350 73rd Ave NE Fr502-4777 20040630 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 ❑ NEW ❑ ADDITION O ALTERATION ac REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Replace 14 windows in home with pocket inserts 9 CHANGE OF USE FROM TO STIPULATIONS Install smoke detectors to meet the State Building Code - in each sleeping room and on each level of house. 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 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $7343 $3.67 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING COW STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $137.2,'x) Fire SC. $7.34 PLAN CHECK FEE TOTA FEE Licens C 5.0 3.26 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI N OP L VALIDA HIS IS yA P RMIT Zr? LO ,NSP 4 MATE L SIGNATURE O� OWNER �Ic OWNER BW�DERI IDATEI x NEW [ ] Effective 1/1/98 ADDN [) CITY OF FRIDLEY 1 ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: ny Legal Description: Owner Name & Address: tA-�h-c i e / ioLto -) oq g aim . 7? Tel. # J 71- a& 3S Contractor. Rpnpl�r. 10 1.4 MN LICENSE # XD L[ Qtg �Q Address: Tel. # a 14%1% Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Construction Type: Driveway Curb Cut Width Needed: Ft. + 6 Ft = Estimated Cost: $ 73 3`.i0 (Fee Schedule on Back) Ft x $ _ $ DATE: �� APPLICANT: VTel. #J�a-$`s� Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee $ Sewer Main Charge $ TOTAL STIPULATIONS: $ IS -3, CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1000 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 [ ] LIVING AREA: Length Width Height Sq. Ft. GA33AGE AREA: Length Width Height Sq. Ft. " DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: 'Ao nI G ry _ r.J1lK rA P # l n—Q� Construction Type: Driveway Curb Cut Width Needed: Ft. + 6 Ft = Estimated Cost: $ 73 3`.i0 (Fee Schedule on Back) Ft x $ _ $ DATE: �� APPLICANT: VTel. #J�a-$`s� Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee $ Sewer Main Charge $ TOTAL STIPULATIONS: $ IS -3, CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1000 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 [ ] SUBJEGT City of Fridley 7;a THE TWINS BUILDING PERMIT ` 57�-�T� RECEIPT NO. ' 1,i -------- COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r 1 ey /Ofc) 1 NUMBER REV GATE PAGE OF APPROVED By i 1 III CITY HALL FRIDLEY 55432 "'j 612-571-3450 810415 8 /98 JOB ADDRESS 1040 64th Avenue NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 3 2 Moore Lake Highlands 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Grace Walton 571-2835 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Hae Concrete Works 6518 Cambridge - d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK O NEW ❑ ADDITION ix ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Install foundation under existing crawls ace to make full basement. 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. WARN lam Before digging call for all utility locations 454-0002 REQUIRED BY LAW 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 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 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 11900 $5.95 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 $187.25 Fire SC 11.90 PLAN CHECK FEE TOTAL FEE 205.10 S G TUAE O/� CON'AACTOA R AUTHORIZED AGENT iDAr 12 WHEN PROPERL V LIDATED THIS IS YO PERMIT r GNATUAE Oa OVVNERf UATTFBl NSP NEW - (] p P Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION o'�a-� ConstructionAddress: q"g 4 Legal Description: Owner Name & Address: , Tel. # Contractor: MN LICENSE # 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: 2AX S- iJice,/ f/!11,1 LIA4l� LsM7ifl, r11A1Zt .�A9447 Construction Type: c -U Estimated Cost: $_ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 571 APPLICANT:A ��'G� Tel. # SSD ^?ZD 2- -7 - CITY CITY USE ONLY Permit Fee $ 72'), Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] ` /0 TOTAL $ASQD�� unOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287 BUILDING PERMIT APPLICANT: HOMEOWNER I understand that the State of Minnesota requires that all residential building contractors, remodelers and roofers obtain a state license unless they qualify for a specific exemption from the licensing requirements. By signing this document, I attest to the fact that I am building or improving this house myself. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building on speculatio or for res le an(A that the house for which I am applying for this permit, located at Tj`7 ® ��f�✓� is the first residential structure I have built or improved in the past twenty four (24) months. I also acknowledge that because I do not have a state license, I forfeit any mechanic's lien rights to which I may otherwise have been entitled under Minn. Stat. 514.01. Furthermore, I acknowledge that I may be hiring independent contractors to perform certain aspects of the construction or improvement of this house and I understand that some of these contractors may be required to be licensed by the State of Minnesota. I understand that unlicensed residential contracting, remodeling, and/or roofing activity is a misdemeanor under Minnesota law, and that I would forfeit my rights to reimbursement from the Contractor's Recovery Fund * in the event that any contractors I hire are unlicensed. Si nature of Homeowner Dat • Ucensed residential building contractors and remodelers are covered by the recovery fund. Licensed residential roofers and manufactured home Installers are not covered by the recovery fund but are required to hold a surety bond. To determine whether a particular contractor is required to be licensed, or to check on the licensing status of individual contractors, please call the Minnesota Department of Commerce, Enforcement Division, at (612) 296-2594, or toll-free at 1-800-657-3602. HALE CONSTRUCTION COMPANY PHONE NO. : 612 915 1519 Dec. 03 1998 10:59AM P2 Hoge Concrete Works is the creator and exclusive installer of TECHNICRETE`D • Beautiful concrete with a lifetime guarantee 10 Member of United Concrete and Masonry Contractors Association Quality Engineered Concrete Work Since 1930 ' Bonded 0licensed • Insured •65T8;CAMBkIDGE STREET, ST. LOUIS PARK, MINNESOTA.415426 PHONE 612.861-4243 FAX 612-9.15-1519. While: Customer Copy Yellow; Office Copy Pink: Salesman Coon N Hage Concrete Works is the creator and exclusive installer of TECHNICRETE® - Beautiful concrete with a lifetime guarantee �` Member of United Concrete and Masonry Contractors Association Quality Engineered Concrete Work Since 1930 Bonded • Licensed • Insured 6518 CAMBRIDGE STREET, ST. LOUIS PARK, MINNESOTA 55426 PHONE 612-861.4243 FAX 612-915-1519 White: Customer Copy Yellow: Office Copy Pink: Salesman Copy a . CITY OF FRIDLEY INSPECTION DIVISION 1 I Effective On January 1, 1998 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS lo (v q Ave Nc 56Lf 3 � RATE SCHEDULE The undersigned hereby makes application for a permit for the 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 Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 30.00 $ _�_0 . UU representations stated in this application are true and correct. (Side Vent - Fill Out Back) / � .1 / a - '1998 Gas Piping (Needed with new furnace) $10.00 $ r� RAC E L4J/S � SO IZ OWNER Gas Range $10.00 $ BUILDING USED AS :JL,�J -e, Gas Dryer $10.00 $ ESTIMATED COST 5 5 O G. Q C) PERMIT N0. *Air Conditioning - All Sizes $ 25.00 $ DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST ON BACK 1 % of Value of Appliance or Work $ No. of Heating Units I Circle One (Steam) (Hot Water) arm A ) Trade Name Lk, Lx,-DSize No. L4.GRg09EZATS CommercialHndustrial BTU 90 , o 06) __ HP EDR 1.25% of Value of Appliance or Work $ Fuel l Connected Load State Surcharge $ .60 Burner Trade Name Size No. BTU HP EDR TOTAL FEE $ 30, S�C� RIVER CITY SHEET METAL, INC. 10105 LINNET ST. NW HEATING COMPANY, COON RAPIDS, MN 55433 MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Signed By Tel No. 9 5- � g C'o y Approved By Rough -In Date Final Date 1 /� FILL OUT BACK SIDE FOR STACVERIFICATION ON REPLACEMENT FURNACE 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 (L,f No ( ) 3. Has no foreign objects lodged within Yes( No ( ) 4. Is securely supported Yes (✓j 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 7. Has a liner been provided for water heater Yes (✓S No ( ) 8. Has combustion air been provided for water heater Yes (v� No ( ) Remarks: List ALTERATIONS Being Done: .01 HEATING CO: Signed By: Date: 1. CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 ! �` q APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 572-3604 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On January 1, 1998 PLUMBING FIXTURE RATES: NO. RATE TOTAL 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 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance 20 State Surcharge $ .50 TOTAL FEE $ ;L-0 I �_o JOB ADDRESS /0q p 6_VAh-e 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. /..17-12 F_ _'1998 Owner L'o 'gm&�a `1% Building Used As Estimated Cost PERMIT NO. )-_X-) y 7 PLUMBING COMPANY V 1,., SIGNED BY TEL N0.�-7 Approved By Rough -In Date Final Date i 6J MINIMUM FEE F R ANY PLUMBING/GAS PERMIT IS $20.00 PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SO INCHES. 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 JOB ADDRESS— &10 A C. /J_ 6 RATE SCHEDULE The undersigned hereby makes application for a permit for the 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 — 301 00 rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ $ representations stated in this application are true and correct. (Side Vent — Fill Out Back) 3-a t( 99f Gas Piping (Needed with new furnace) $10.00 $ OWNER DAy c _LN -0 e -A r{ U-5- Gas sGas Range $ 10.00 $ BUILDING USED AS. Gas Dryer $ 10.00 $ ESTIMATED COSTS PERMIT NO. mod *Air Conditioning — All Sizes $ =90$ DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST ON BACK 1% of Value of Appliance or Work :95-4-5 $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. Commercial/industrial BTU HP EDR I% of Value of Appliance or Work $ Fuel Total Connected Load State Surcharge $ 50 Burner Trade Name Size No. BTU HP EDR TOTAL FEE o'l$ G ` I-5' HEATING COMPANY �i Iy�JP,f /�c✓C,, 6 MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION n, !�/ REFRIGERATION/AIR CONDITIONING PERMIT IS $ie-Woa Signed By Tel No. ' tf7 PLUS THE x.50 STATE SURCHARGE 00 REINSPECTION FEE $3"0 Approved By Rough—In Date Final Dat7eh�j� *Air Conditioners can not be placed in a side yard without /0P�/(�l written permission from adjoining property owner. FILL OUT BACK DE FOR STACK VERIFICATION ON REPLACEMENT FURNACE NOTE: #1 through #8 required when using a side vent furnace. CHIMNEY AND STACK. VERIFICATION The undersigned hereby verities that the existing chimney or stack: I . Has been carefully examined Yes () No ( ) 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 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: Yes ( ) No ( ) Yes( No ( ) Yes () No ( ) Yes ( ) No ( ) Yes No Yes No List ALTERATIONS Being Done /UCS d7uoT �rF?ST�M %M E71ClST1.ve FUe,%J }-e..5 HEATING CO: Signed By: Date: SUPERIOR CONTRACTC)PS Q- 6121 42nd Avenue Wo. SUBJECT City of Fridley 30475 AT THE TOP OF THE TWINS BUILDING PERMIT 0. COMMUNITY DEVELOPMENT DIV. ------ PROTECTIVE INSPECTION SEC. ri��7 6�® r NU;BE" REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 .j L 612-571-3450 1 910415 11/3/99 J013 ADDRESS 1040 64th Avenue NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 3 2 Moore Lake Highlands 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Grace Walton 550-9202 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Great Northern Resources Inc 9109 Davenport St NE Blaine 55449 784-0162 20117027 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 0 ADDITION O ALTERATION XX REPAIR O MOVE 0 REMOVE 8 DESCRIBE WORK Reroof house and garage 29 S Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with 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 BO 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 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2535 0$1.27 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 Firq SC $2.54 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TO FEE License $5.0 .06 SIGNATURE OF CON TRACTOR OR AUTHORIZED AGENT IDATEI HEN O VALI THIS IS YOUR PER S-GNATURE OF OWNERJF OWNER BUILDER) IDATEI BLPt INSo pATt NEW [ ] y Effective 5/10/99 n ADDN [ ] CITY OF FRIDLEY \" l ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION �" 1 Construction Address:/ L — U..,IV IEE Legal Description: Owner Name & Address: 6r, (e �� k Tel. # S"5-0- 170 Z Contractor: MN LICENSE # Zo l 17o z 7 Address: Tel. # 7Jy 0/6 z Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: 14 25 Construction Type: r., o�� rrroo�� Estimated cost: $ 3/0 y Driveway Curb Cut Width Needed: DATE: /I J 3 / q,7 APPLICANT: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Ft. + 6 Ft = Ft x $ CITY USE ONLY Fee Schedule on Reverse Side 001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1050 per SAC Unit 159 Tel. # $ S, 0 O $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ 9 a, 04 Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Effective On Jan 1, 2000 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR : ..::::::::#>> :>+:::::_ Urinal '1'# Shower :: Wash i<:<: Tra ><>::: €>>€ Floor Drain :::;:: Auto. Washer';::>}` :—:::<::<:::>: Gas mange «I< Water Heater Stones ; Gas Elec en Basem t Floor 1 Floor 2 I r3 F o0 Floor 4 PLUMBING FIXTURE RATES: 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** NO. RATE TOTAL 3 -A-3 Gas Dryer** _ Back Flow Preventer Required ( )Yes () No $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 Type $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance ':�?/. o0 Al? 100 State Surcharge $ .50 JOB ADDRESS /0 YQ 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 Owner Zr "'/'j J" aV s'. Building Used As / L � Estimated Cost PERMIT NO. PLUMBING COMPANY SIGNED BY Approved By'= Rough -In Date L 4- . Y✓ S' �V GYM//Cp� TEL N0. 6 rZ F6 7 '7q5-7 Final Date TOTAL FEE $�Sz PLUS THE 5.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A COMMON VENT INFO ON BACK SIDE COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes( ) No( The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to Install a new combustion air, it will be sized and installed To meet the current codes and manufacturer's specifications. Yes () No ( ) When Installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes( ) No ( ) ARpliance Tvve 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 I 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 : Building BUILDING Permit No ' 1 Inspections RESIDENTIAL APPLICATION Received By: 763-572-3\604 CITY OF FRIDLEY Dat��'�d� c R ..2 20 DATE ,—I YJ O� YOUR E-MAIL ADDRESS SITE ADDRESS �� -- �Q Luk Y%� THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ NAME: &4 (U TENANT ADDRESS: CITY STATE_ZIP PHONE:619 .. F' I ^ Q 515 NAME: Renewal By Andersen CONTRACTOR SUBMIT A COPY OF STATE LICENSE #_ 1920 County Road "C" West YOUR STATE LICENSE ADDRESS: Roseville, MN 55113 —STATE—ZIP— WITH APPLICATION PHONE License #20130983 ❑ SINGLE FAMILY/N0 PROPERTY TYPE ❑ TWO FAMILY/NEW G 651-264-4.777 _ ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS PERMIT TYPE ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan PROPOSED SIZE: ❑ DETACHED GARAGE 2. Proposed floor plan PROPOSED HEIGHT: 3. List of structural members to be used SIDING ❑ Vinyl ❑Soffit FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Aluminum ❑ Other ❑ Trim ADDITIONS_ 1. & PORCHES SUBMIT: Site Plan/Survey showing the existing structur ❑ Fascia and proposed project WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS Aa.a, r ar a Ax>r ISA ED VN VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ St R b — OCCITPAN('V TVPT Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1550 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: Citv of Fridlev Attac THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be conformance with the ordinances rd codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not permit but only an application f a permit ork is not to start without a permit; that the work will be in accordance with the approve plan in the case of all work whi uires re i and approval of plans. SIGNATURE OF APPLICANT NT NAMEOYYi Y ► J G ((` ) y1 DATE