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PRE 2010 DOCSI Village of Fridley, Minn. SIDING PFJtM" N° 26'3 Office of INSPECTOR OF BUHMINGS s Architect P Fridley, Minn., 18.E Builder a OC TION OF I UILDING No. Street Part of Lot Lot it Block Ad tion or Sub -D on i DESCRIPTION OF BUILDING 1i�IiI � Front Depth Height Stories Manner of Construction-- onstruction To To be used !i To be comple ed F1- t !' Estimate cj Cost / rte€ ox I Permit is hereby ted to to 7 the buildln escri in the above statement. This permit is granted upon the express co 'dition that the person tJ whom it is granteand his agents, employees and workmen, in all the work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordi- nances of Fridley, 3 regarding the construction, alteration, maintenance, repair and moving of buildings within the city limit , and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. Easpector of Buildings. I' AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by the Inspector of Buildings of. Fridley of the above permit; I hereby agree to do the proposed work in accordance with the description above set forth;" according to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby tate and say that the facts stated by me and contained in the above permit are true as therein stated.. Subscribed and'Isworn to before me at Fridley, Minnesota!; th' V day --r o �,� . t- � 1— .D. 19 s N° 2 Village of Eri.dley,11' m. BUILDING PERXrF Office of INSPECTOR OF BUiiLBMNGS 19---.D Fridley, Fridley, Minn. LOCATION nOF BUILDING ���� ,� �_ a street Part of Lot Block Addition or sub -Division OF BUILDING Front Depth ^'- Height stories / Manner of Construction ar,t i Estima ed Cost To be used as �';a� To be completed - �, Permit is hereby gaIlted to—L' y the building �� `„' ` * described in the above statement. This permit is granted upon the express c clition that, the ierson to Ivhom it is granted, and his agents, employees and workmen, in all the work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordi- nances of Fridley, Man., regarding the 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. V- !— inspector of Buildings. In consider the above perr above set forty sworn, I herebi true as therein Subscribed AGREEMENT AND SWORN STATEMENT >n of the issue and delivery to me by the Inspector of Buildings of -Fridley of I hereby agree to do the proposed work in accordance with the description d according to the provisions of the ordinances of Fridley, and, being first duly ate and say that the facts stated by me and contained in the above permit are sworn to before me at Fridley, day of A.D. 19 I �I II I' it II Minnesota, ,:th a is Application for Power Plants and Healing. Coding, Ventilation, -Reh igeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL, Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 60,000 BTU ....................... 2.00 $ Replacement of Furnace 6.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam_ ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ C Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE c ROUGH — A f INAL Dept. of Bldgs. Phone SII, 4-7470 Location 43 ye " to ��r� , au, Z). 60° City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Aunn Owner Kind of Building , Used as To be completed about Estimated Cost, $ Old' New. Building Permit No. Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No Trade Name Size No Capacity Sq. Ft. E.D.R. BTU H.P. Total Connected Load Ila �� Kind of Fuel BURNER — Trade Name . '!� Size No- Capacity, o Capacity X5 b Cri5'20 Sq. Ft. E.D.R BTU H.P. (REMARKS -OVER) Sign CC�� By 4 z 2M 7.59 Business Phone No- v' STATE OF MINNESOTA DEPARTMENT OF {HEALTH ABANDONED WELL RECORD I. �� 1�L1 MINNESOTA UNIQUE WELL N0. 1 (leave blank if not known) County Rama Anoka Township Rases Tmmship RurNRange Number Soction No. Fraction 4. WELL DEPTH (completed) Date sealed Brian Peterson N H Al bof % 313 Plastic 60 Stainless Steei in. to ft. HARDNESS OF 3. FORMATION LOS COLOR FORMATION FROM TO Fridley 30 21' 13 h''W "E 84 +t• 9/20/89 s W ® Open tote from ft. to ® ft. Numerical Street Address and City of Well Location or Distance from Road S. DRILLING !METHOD (if known) Intersection 0 Cable tool 40 Reverse 7® Driven 1613 On 1340 64th Ave. NE a® Rai law Rod go Air C Bared 110 30 Rotary 60 Jetted U Pmmr Auger 11. WELLHEAD COMPLETION 1® Pitless Adapter 40 Found Buried Show exact location of well (in section grid with °K°) Sketch map of well location 6. OBSTRUCTIONS M oL,p UAM L Well obstructod ® Too ® Ifo W MEN= 7® Air Conditioning 11I 2. PROPERTY OWNER'S NAME ®®M S. CASING(S) property address indicated above 10 Black 40 Tkroaded 7[3 Brian Peterson 6200 Dupont Ave. N. %GRIT. 13Welded Brooklyn Center, IN. 313 Plastic 60 Stainless Steei in. to ft. HARDNESS OF 3. FORMATION LOS COLOR FORMATION FROM TO Obstructions removed ® Yes ® No If obstructions cannot be ® removed. contact KOH E A kefaro $asling. IPJ1. USE T �. 1 Domestic 413 Monitoring I0 Heat Loop I 213 Irrigation 50 Public go Industry 1 30 Test Well 60 lumicipal IC Commercial a� L wi�=�� 7® Air Conditioning 11I 2. PROPERTY OWNER'S NAME Mailing Address if different than S. CASING(S) property address indicated above 10 Black 40 Tkroaded 7[3 Brian Peterson 6200 Dupont Ave. N. %GRIT. 13Welded Brooklyn Center, IN. 313 Plastic 60 Stainless Steei in. to ft. HARDNESS OF 3. FORMATION LOS COLOR FORMATION FROM TO If not known. indicate formation log from new well or nearby rail. in. to ft. 2. SCREEN ® Screened wall from ® ft. to ft. (If known) ® Open tote from ft. to ® ft. 10. STATIC WATER LEVEL ft. ® below ❑ above land surface Date Measured 11. WELLHEAD COMPLETION 1® Pitless Adapter 40 Found Buried Basement offset e0 Wali Pit 16. REMARKS. ELEVATION. SOURCE OF DATA - CASINGS REMOVED. CASINGS PERFORATED. ETC. 12. GROUTING INFORMATION Neat Cement 20 Bentonite 30 2" well, 84 ft. la" from house • deep Grout meterialP,mt.]and1romQ—to-Uft. cu. yea _ 2, -bags 13. MEANEST SOURCES OF CONTAMINATION feet direction type Well disinfected before staling? ® Yes 14. PUMP I rRemoved ® Not Present Type: 1Q Submersible 30 L.S. Turbine 0 Reciprocating Jet 40 Centrifugal 6J3 - 15. EXISTING WELLS (Please sketch locations of abandoned and active wells in remarks sect on or an back.) Other unused wells) on property? ® Yes JKNo Abandoned: [❑ Permanent [3 Temporary ® Rot sealed 17. WATER WELL CONTRACTORS CERTIFICATION This well was sealed under my jurisdiction and this report is true to the best of my knowledge and belief. LicenWe ,rasa Mame License No Inc.02484 Addrssa l r Signal Date 9/20/89 Oats Now of Driller OFFICIAL ABANDONED WELL RECORD (May be used for Property Transfer) ZNPURT.1Wp'!a PZ219 WXW J» MINIMUM FEE FOR ANY HEATING/COOU-NGIVENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 1 *Air Conditioners can not be placed in a side yard without whaen permission from adjoining property owner. HEATING COMPANY M0459 #ez4'''' j * A tz Signed By cP *� Tel No. 536.-0667 Approved BYaLZ Rough -in Date Final Date .121.- FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE -7to3? CITY OF FRIDLEY INSPECTION DIV. Effective On January 1,199y 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 �!31-/0- ICRATE RATESCHEDULE 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 $ 20.00 $ � representations stated In this application are true and correct. (Side Vent - Fill Out Back) / a Gas Piping (Needed with new furnace) $10.00 $ S A A gw nJ Q A /" rSEy OWNER Gas Range $10.00 $ BUILDING USED AS Gas Dryer $10.00 $ ESTIMATED COST & Y600, CSU PERMIT NO. *Air Conditioning - All Sizes $10.00 $ DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST ON BACK) % Units Circle One Water) arm Ai 1% of Value of Appliance or Work J)� $ a 0 No. of Heating (Steam) (Hot Trade Name Size No. -5 FIs t1?Q6011Y' Commercial/Industrial BTU & d> ® HP EDR I% of Value of Appliance or Work $ Fuel IV A% Total Connected Load State Surcharge .60 Bumer Trade Name Size No. BTU HP EDR TOTAL FEE q5 5-0 MINIMUM FEE FOR ANY HEATING/COOU-NGIVENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 1 *Air Conditioners can not be placed in a side yard without whaen permission from adjoining property owner. HEATING COMPANY M0459 #ez4'''' j * A tz Signed By cP *� Tel No. 536.-0667 Approved BYaLZ Rough -in Date Final Date .121.- FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE NOTE: #1 through #8 required when using a side vent furnace. CHIMM _MM AN. ► STACK i. Y__ : M..:..YM The ►► ► vied hereby verifiesthat ►i existing ► iui 1. Has been carefully examined Yes (,No ( ) 2. Is free from rust or deterioration Yes (4No ( ) 3. Has no foreign objects lodged within Yes( -�'No ( ) 4. Is securely supported Yes ( �No ( ) 5. Meets all current Code requirements for size and total BTU'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 ( ) No (�} 8. Has combustion air been provided for water heater Yes ( ) No (-�- Remarks: w /L �✓�/.'r�/iZ� ,s PIOC all List ALTERATIONSftfg HEATING CO: Signed By: Date: 5r9,5- HOUSE UZATING TEST ttt:coRn ADDRGS_ !,3 YO T i4Vf- APT. FLOOR _ CtTy _SUBURB_" OCCUPANT <A iJ Q�Av�S 4- OWNER ' HEAT LOSS DATE I1TC. INST. SOLI) By. at STALLED IIY_____G — -- 4bcCC:lca-l. Mork BY, Cas Linc By __ •' UNIT 11TR.• OTHER TYPE OF IIL•'AT: GA Fr �lII1� STF.1�J•t S�'�ICT± IITR. ..._.�� . • CAS Dtszcrr Cownslox• 14AKL' OF. BURNER 5Tm uP0(oy t1, q. Modcl Max. BTU Ratin . INPUT�O�.00(� tllli.L Or FU RCE . Noacl r• - C011TROLS THERrlu:,i.� �i7_Ileat P1uR Vent Size 7 I V c valva KIND OF L::14r tSIZE NONE Limit —1*1e •-,a ,sem Draft Hood Rcrulator Limit Sctting /7t� Filters; Siee I �O I Number•% _ Fan Setting' SO Ssx- Chimney Location: 'Inzidc Outside Pilot Type 'k-15--TCiii=cy Construction, Pilot Make* 4- Pilot Model Smoka Bomb Wirinf, Yllo t iimin(I -� Draf t Test Tar L.W. Cut Off Door Preasure LiEhting Inst.__, Pressure a. 5 percent co • 1-1 Date Tea tcd - Input CFtt t QI o o Pcrccnt 0Z _ Company Tcatinr 2 Stack Temp.- Pcrccnt CO !e Name of Tcs ter o _ • ri SUBJECT RMIT NO. of Fridley � � � AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. If?City � COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 6/24/96 JOB ADDRESS 1340 64 Avenue NE I LEGAL LOT NO.BLOCK TRACTOR ADDITION SEE ATTACHED DEscR. Pt 15,16 2 Spring Valley Addition I SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ramsey 1340 64 Avenue NE 574-4465 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Ricks Roofing & Siding 77 2 St SE, New Brighton MN 633-6395 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 a ❑ NEW ❑ ADDITION El ALTERATION x REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House (14 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING 1 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE DCO ECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINA S GOVERNING T S TYP OF WORK WILL BE COMPLIED $1,155 $.58 WITH WHETR SPECIFIED HEREI OR THE GRANTING OF A PERMIT DOES NOT RE UME TO GIVE THO Y TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PRO OF ANY OTHER 5 TE LOCAL LAW REGULATING CON- $40.25 Fire SC $1.15 CTOR THE PERFOR CE ONSTRUCTION PLAN CHECK FEE TOT FEE Li ens SC $5 0 $46.98 OOF //I NA7 E PROP VALIDAT D THIS IS YPUR PERMIT 00/ iGNATU E OF OWNER OF OWNER BUILDERi iDATEi WDG 1N5 70 9AT ri zl tl i/ ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress: �® (o t-% �� tkE r Z C Legal Description: g P �' (�A t Gwl"� A4.5' bS"16 Effective 3/1/96 F-,?, -6l� Owner Name & Address: atn S v Tel. # S-- % Contractor: I S� / MN LICENSE # Address: 77 a7� d S/ 5i-- Rk1!c ka= Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EVIPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: /1 7 Estimated Cost: $ v / / 5 ; Approx. Completion Date: (Cost on Back) f Driveway Curb Cut Width Needed: Ft. + 6 Fte= Ft x $ _ $ DATE: - 9�APPLICANT: �Ud� Tel. # Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $900 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 P City of Fridley 2 5 38 6 AT THE TOP OF THE TWINS BUILDING PERMIT r ' , I RECEIPT COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. i NUMBER REV DATEPAGE 8/19/97 OF APPROVED 8V = CITY HALL FRIDLEY 55432 612-571-3450 910415 JOB ADDRESS 1340 64 Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt 15,16 2 Spring Valle Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Sharon Ramsey 1340 64 Avenue NE 574-9332 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Murphy Bros 1613 93 Ln NE, Blaine MN 55449 780-3262 3416 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO, 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW C ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 27' x 12' Addition to House 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. oftsm WARNING Before digging call for all utility locations 454.0002 REQUIRED BY LAW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $17,798 $8.90 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- $262.25 Fire SC $17.80 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE License SC $5.00 $293.95 TURE (:)FQ0jTRACTOR OR AUTHORIZED AGENT $DA EI EN PROPERLY ALIDATED THIS IS YOUR PERMIT ��;e a $NSP GATE _ SIGNATURE OF OWNER OF OWNER BUILDER$ IDATEI IBLDG NEW ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AN R>2 BUILDING PERMIT APPLICATION N ConstructionAddress: Legal Description: i 0 F /S (/� r G2)�',�l '21 cS � o k-)�� Owner Name & Address:Tel # 74 -S37 Contractor:/( Ups MN LICENSE # --Sr$ Address: _ ) I 9-1kb Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EWPROVEMENT LIVING AREA: Length � ;_ Width 2,7_ Height I STeW-Y Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft.�'�0 7� DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type:— Tim s' Estimated Cost: $ (Wee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ftx $ _ $ DATE: -4-9-7 APPLICANT: 1b Tel. �62' Z5- CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge ��, $ J147acr .001 of Permit Valuation (1/10th%) State Surcharge X,10 $__,&:r $.50/$1,000 Valuation SAC Charge $ /� $950 per SAC Unit License Surcharge Driveway Escrow $ . Erosion Control $ Park Fee $ Sewer Main Charge $ STIPULATIONS $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 [ ] v !n"Iraces Monument. Description: The Fast 114.00' of Lot 15 and the East 114.00' of Lot 16 - Block 2 - Spring Valley Addition Fridley, Minnesota / Ftr'C:I�TFRF.D LAND SURVF.l Actual Foundation Location AV E. N. E. 116 /3 14 64 o / Ftr'C:I�TFRF.D LAND SURVF.l Actual Foundation Location AV E. N. E. 116 /3 14 CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Rath Wash Eink .. ;Floor Ouch Auto. Urinal Tub ,; Shower Sink Tray Fouhi Drain Baan Washer PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 7.00 7 0� Old Opening, New Fixture $ 4.00 Beer Dispenser $ 5.00 Blow Off Basin $ 7.00 Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank $ 7.00 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/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance 70, D V State Surcharge .50 TOTAL FEE $$"U JOB ADDRESS_ Effective On January 1, 1997 Gas Mise Water Heater Range Fust,..... ; Gas E I eec 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 Building Used As 3 1997 S"7y- 9 3 2Z Estimated Cost _ 7 S PERMIT NO. PLUMBING COMPANY�iif SIGNED BY ��G?' �G'L �/ TEL N0. Approved By Rough—In Date Final Date MINIMUM FEE F R ANY PLUMBING GAS PERMIT IS $20.00 PLUS THE'$.SO STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES. U SUBJECTW N -a- city of Fridley 3 9 7 6 AT THE TOP OF THE TWINS BUILDING PERMIT r? r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 1 NUMBERREV DATE PAGE OF APPROV BY i -�-1 - CITY HALL FRIDLEY 55432 763-571-3450 910-F15 10/16/03 JOB ADDRESS 1340 64 Avenue NE 1 LEGAL LOT NO. I BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. rt 15,16 Z Spring Valley Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Sharyn Ramsey 1340 64 Avenue NE 763-574-9322 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Sussel Corp 654 Transfer Rd, St Paul, MN 55114 651-645-0331 1934 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK NEW 0 ADDITION 0 ALTERATION 0 REPAIR O MOVE 0 REMOVE 8 DESCRIBE WORK Construct a 22' x 20' Garage; Remove existing 20' x 14' Single Garage 9 CHANGE OF USE FROM TO STIPULATIONS 010011111 See notations on pian. Provide a hard surface driveway. Before digging call t0� all utility locations 4540002 F0) BY LAW SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 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 @@ @@ $7.00 WITH WHETHER SPECIFIED HEREIN OR NOT THE GRANTING OF A PERMIT $14,000 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- Fire SC $14.00 CONSTRUCTION $237.25 yx:aT- LAN CHECK FEE TOTAL FEE �// ® Li nsk SC $5.00 1 $263.25 SIGNATURE OF CON7AAC0 AUTHORIZED AGENT IDATEI EN PR P RLY VALIDATED THIS IS YOPF PE MIT $�GNA LURE OF OWNER SIC OWNER BUIIDERI (DATE. G INS fI �E U 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: ),:?��i U� Legal Description: Owner Name & Address: Tel. # "'% e 3 , :G7'10- � 9 3-'Z Contractor. MN LICENSE # Address: (,2 S 91.0.5-2 09 � �7- Q�v�� ms`s 1 I � Tel. # z.5! X03.3 1 LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Z. Z Width Height I I Sq. Ft. 4<16 c �- 47�8f��D Construction Type: Estimated Cost: $ i -4 ,mxnb Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: CL ),®3 APPLICANT: Tel. Call (763) 572-3604 for Permit Fees if mailing in applicatio / ax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge $ 7 �� $ ab $ $ r TOTAL $ ,'G 3 - Z Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1275 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 [ • #3650 --® Ms. Sharyn Ramsey iffe! INS 5% 1340 64th Ave. NE AM Fridley, MN 55432 654TRANSFER ROAD, suITE 1s13 H763-574-9322 ST. PAUL, UIN 55114 Permit b 4 4 20x22 Det. Allbilt W/Conc. Legal Description 9/24/03 Dennis Jamot Lot: 03 Blk Add'n vaiuR Builders License 97 934 Type Const.._. SLAB: ZBY SUSSEL ❑ BY Owner Approx.- 01n pprox. ❑In 2 -STARTING POINTS ONLY _ _ . ... _ dE: 4E: —SIZE -- _ x ONE ROW BLOCK 4 SIDES � lo cks• y Sussel ❑Wtr.proof: ❑By Own. ❑By Sus ❑Backfill: ❑By Own. ❑BY Sussel n ` „ X OVERHEAD DOOR M.0.16'3" Maintains' total Wall Height OR SERVICE DOOR M O 41" Including Blocks ❑ Maintain B' all Height on Top of Blocks Block Size flop course) - -- Q B �'6 0 4_ Wall Height other than 8'x_ _ e ❑ C Ia 11 ACCESS ❑ Good ❑ Fair ❑ Poor MIn/N 1 A OC r3 'C IIII 1r AI C - DIRECTION SUS SEL G GE S �12 ROOF: ( ABLE REVERSE GABLE HIP EAVE OVERHANG: d RAKE OVERHANG: +- SEAL DOWN SHINGLES WITH PLYWOOD OR WAFERBOARD ROOF SHEATHING AND 15 LB. FELT. Roof Sheathing Seal Down Shingles \ / Ice and Water Protection Trim Manufactured Trusses 2" x 4" Dbt rrlple _► 1" x 4" Top Plate Sub Fascia NOTE: Fascia Soffit 1) Roof approved by Minnesota State Buliding Dept. as meeting Minnesota State Code Requirements of 40# snow load. 3/4" Cove ons ra es , ru RAFTERS: Trusses @ 24" O.C. 2" x 4" Studs STUDS: 2" x 4" 16" O.C. �j I U 4—Siding WALL SHEATHING: j SIDING: v' +V -..j ✓ OVERHEAD DOOR HEADER: Double Tx 12' or 2 - Micro Lams x a 2"x 4" studs 2"x6" Treated Bottom Plate Sill Sealer 1 n 1 Row 6" Concrete Blocks 1/2" x 7" Anchor Bolt W/140 -8w `1113 Tb slab 2" x 4" Treated Bottom Plate SLAB: NOMINAL 4" RE .INFORCED CONCRETE °f Above Grade _. _._._._._.._. _._._._._._._._._._._._._._._._._._ .................... j 811 I Grade H m - s -v rna - nn 1 LM CD >>.n `moo r�m� C)caT+ m =-� m LCD -o- m OCC t �----3 T 25 o� m e, 0 2 ro r i.-.--1, •--3 - s w -aro -i x x x .ruz 00 l a r4 .: p. + "�'. dd . Z r -t D rm s -r. m tat - ��. 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