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PRE 2010 DOCS0 i is City of Fridley, Mian.. BUILDING PERMIT C -q- 4)(Val N® '7065 Date: B Owner: altdL, Builder A _ ---- Address Address l/� O TION PF BUILDING No. Street�_F Part of Lot Lot �__ Block _____ _ — A ._ tion or Sub -Division Corner Lot _ Imide Lot �� Setback -��� _ Sideyard M A Sewer Elevation �-3 Femlihdt®n Elevation ?35-' ?5� T o or- FUa7i.y� DESCRIPTION OF BUILDING T Used Front Depth `I V Height _ Sq. Ft l -G 4 Cu. Ft.�� c: if Front Depth Leight Sq. Ft. Cu. Ft. Type of Construction - 444 a Est. � D 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 and in compliance with all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ fj permit is hereby granted to the to construct the building or addition as described above. This permit is granted upon 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 F hin the dty limits and this permit may be revoked at any time upon vi9]ation of any of the provisions of said inances /� w NOTICE: Tbb permit does not corer the construction, hntaibtion for wiring, phanbtne, ger heating, cower or water. Be sure to on the Bulldtng Inspector for separate permlte for than items. City of Fridley Application for Plumbing and Gas Fitting Perndt Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK Number, Kind and Location of Fixtures rn NO. RATE TOTAL Number Fixtures ...................... x $1.50 $--f" Future Fixture Opening ................ x 1.20 Y New Fixture Old Opening .............. c Z g x 3.25 w o a z O • P • N I WATER HTR. GAS ELEG Base NO. RATE 9TOTAL 1st 3 Fixtures .......................... ' -Q Additional Fixtures .................... B $ Gas Range to 200,000 BTU .............. x 2.00 $ 1st % 2nd _ 3rd _ 4th • Future Connection Openings New Fixture, Old Openings Connected with Sewer � Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 $--f" Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 ®Q' $ —R— New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE 9TOTAL 1st 3 Fixtures .......................... x $1.50 -Q Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description................................................$ TOTAL FEE o 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 ag true and correct. Fridley, Minn.— iI ��� P Owner Kind of Building Used as To be completed about FIA Estimated Cost, $ la 6a o �® Ol New Building Permit No / (1�rmit f> l ROUGH FINAL 4 z 2M 7_59 By. Phone 14 19&Y (T City of Fridley, Minn. N' 10752 BUILDING PERMIT Date: _ July 15, 1970 Owner: Lavern Dornbusch Builder Same ,Address 40 - 64th Way N.E. Address Same LOCATION OF BUILDING No. 40 _Street 64th Way N.E. --- Part of Lot Lot 4 & 5 -_ Block _ _ Addition or Sub•Division . Fri d ey Park✓ Corner Lot — Inside Lot —X Setback — Sideyard Sewer Elevation _ Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Garage Front _ 16 Depth __ 24' _ Height _LQ Sq. Ft. 3.84-- Cu. Ft. 3840 Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Frame: Est, cost _ $1400.Dn _ To be completed 7 115 1.71 Provide a hardsurfaced driveway. 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 and in compliance with ah provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $-j. 00 , permit is hereby granted to Lavern E. DQrnbusch to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construciaton, alteration, maintenance, repair and moving of buildings within the dty limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. NOTICE: Uls permit does not cover the construction, InslaUaMon for wiring, plumbing, gas heating, sower or water. Be sun to we the Building Inspector for separate permNa for thus Rena. 9 0 APLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME: 1��' C a'/ . I - A v eN BUILDER: ADDRESS: --'/0 ,J -19Y ILI F. ADDRESS: Sa.7m E NO:..- STREET:_ C^ y f/V ttI' , rli. LOT: - S� BLOCK: /S ADDITION • ✓r K' 1 j7Z t- y 14 R A CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. To Be Used As: DESCRIPTION OF BUILDING Front:° Depth: Height: Q Square Feet: Cubic Feet: Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: � , Estimated Cost: To Be Completed: ,Tu L J S The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in sttict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE:' � �' f S � � SIGNATURE (See Reverse Side For Additional Information.) Land Planning ��i �"G�TAi 6875 Nlghway Np.6$ N.E. Land Surveying • Minneapolis, Minn. Soils Tepting �%�Zpi��G�i� rJi✓s Minn. 55431 Civil Engineering Telephone 784-6066 Municipal Engineering Engineers & SUrvey'f re Area Lode -612 Mortgage Loan Survey for � 4 tGRI\l /_ ', , , % AlAY i fix, �F�nn I c1 M 4(- I + 0 f cs IN .9.5 1 i-0 40 t_ L07-5 '.4- ' 5, BLOCK /5 , F -RI DL Y ,alloK�► cr�uvr°r This is a true and correct representation of a survey of the boundaries of the land above described and of the location of all buildings, if any, thereon, and all visible encroachments, if any, from or on sold land. This survey is made only in connection with a mortgage loan now being placed an the property and no liability is assumed except to the holder of such mortgage or any other interest acquired by the reason of such mortgage. It is understood and agreed po monuments have been Placed for the purpose of establishing lot lines or boundary corners. Dated this day of - %,A1! 1_A. D. 1970. —r- SUBURBAN 1INGINIMUNG, INC. L� Engine s Sury �4 - bye, c' K/ c. r SUBJECT P IT NO. City of Fridley ® 0120 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIP L-_ COMMUNITY DEVELOPMENT DIV.��� INSPECTION r � � PROTECTIVE SEC. 1 . i CITY HALL FRIDLEY 55432 NUMBERREV. DATE PAGE OF APPROVED BY 612-660-3450 910-F15 JOB ADDRESS 1 LEGALCT LOT NO. BLOCK TRA OR ADDITI N SEE ATTACHED DESCR. 4 & 5 15 FRIDLEY PARK SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE LAVERN DORMUSHCH 40 - 64TH WAY N.E. 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. 4 ARCHITECT OR DESIGNER MAILADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING RESIDENCE 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION XX REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK RE -ROOF DWELLING 9 CHANGE OF USE FROM TO STIPULATIONS 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 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 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 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE SIGNATURE OFCONT TOR OR AUTHORIZED AGENT (DATE)WWHENPRROPERRVVALIDATED �SIGNATURE THIS S YOUR PERMIT INSP DA OF OWNER IIF OWNER BUILDER) ID TEIBLDG c' K/ c. r -APPLICATION FOR RESIDENTIAL,ALTL'RA1'ION, OR ADDITION.BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWER' S MID: L A L1c rAJ -00 ,'AJBuS(//BUILDER: • ADDRESS : 6917-1-1 C✓A y Al, F, ADDRESS: NO:. o STREET • l� 7` T/� W,9)1 A), LOT: BLOCK: /S_ ADDITION: CORNER LOT: INSIDE LOT: SETBACK: _- SIDEYARD: • I Applicant attach to this form Txao Certificates.. -if Survey .of L-ot and .proposed • ' building location drawn on these Certificates. .DESCRIPTION OF BUILDING To Be Used As: Front: Depth: Height: .- Square Feet: Cubic.Feet: • Front:' Depth: Height: Square Feet; Cubic Feet': • ' =V/0, 00 Type of Construction: eE-,eooF VW r1Lrn/L Estimated Cost: $ To.Be Completed: The 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, and hereby declares that all the facts and representations stated in this application are true and correct. • DATE: TUGS 3 / _ SIGNATURE: ae,_e,,, +--� (See Reverse Side For Additional Information.)' City of Fridley SUBJECT 9 931 r-1 AT THE TOP OF THE TWINS PERMIT BUILDING CEIPT v _����_ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. /j `� 3a I � � "1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 9/20/78 JOB ADDRESS 40 - 64th Wav E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4-5 15 1 Fridley Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lavern Dornbusch Sae as a560-5729 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Owner 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING 7 CLASS OF WORK ❑ NEW ❑ ADDITION )CI ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Finish basement 9 CHANGE OF USE FROM TO STIPULATIONS In bedroom. 5 � 1. Provide escape wi ndVos �, �Q� �� CPLJG� 2. Mechanical vent if window area is less than 10% of floor. (3) '--*kIlzo Pea i�x "r—\4L,.%d Guu c rca.,r,C S1��►�` r ► VL IfIc to L dc" -- 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 SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 $4,000.00 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $26.00 GNATURE OF CONTICTOR OR AUTHORIZED AGENT IDATEI 9-20-78 WHEN PROPER VALIDATED THIS IS YOUR PERMIT 9-20-78 BLDG )NSP DATE SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PE11141TS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER: �/y� Pl� Jopdgcjs(�l BUILDER: Address:* '10 - Ir? `/ T11 64JAl AIJ-C- Address: Tel. No.: No. Street: T'7 (A) ?9 1J -C •�i�l %� L E / �A LOT: � BLOCY.: 'ADDITION: �� CORNER LOT: INSIDE LOT: SETBACK: SIDDYARDS: Applicant attach 'to this form T<•io Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: �i �✓i S Ji Q �S��Eont: Depth: Height: . Square Feet: Cubic Feet: Front: Depth: Height: Square Feet: Cubic Feet: • Estimated Cost: $ `7, D D o 0 00 Type of Construction: To Be Completed: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired $ $ (SEI: REVERSE SIDE OF SHEET) The 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, and hereby declares that all the facts and representations stated in this application are true and correcct. See reverse side for additional information. DATE: -a0- 7E, SIGNATURE: -Z� Stipu ti s: 0 P (16 0% 0 i) OESC C 0-`o S IN C)d j f/J' / VJ� q QZlUd � oI (C) % o ►�' F� a6,Od CITY OF FRIDL EY APPLICATION FOR PLUMBING AND GAS FITTING PEF44IT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL V) ro 9,00 o g $3.00 m Future Fixture Opening Water y t� myy x $2.00 $ H rd $5.00 $ Water Heater - to 99,000 BTU c4J n, w 100,000 BTU to 199,000 BTU x Heater .�i N 0 d A $7,00 C New Ground Run Old Building m ,yp� B r. Gl Spa .G 9 8 N Qa, GAS FITTING FEES: 1a C lst 3 fixtures x 0 0 b .11 x $1.00 R Gas Range to 199,000 BTU •.a O O +� u`4l tOrO of u�i '� oN! W U D w W ai 3 A w° vii w U w 3 Cbl $ c`� 0Bas as lec P t j / 1st 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL 9,00 Number Fixtures g $3.00 $ Future Fixture Opening x $2.00 $ New Fixture, Old Opening x $2.00 $ Catch Basin x $5.00 $ Water Heater - to 99,000 BTU x $5.00 $ 100,000 BTU to 199,000 BTU x $10.00 $ Water Softener x $7,00 $ New Ground Run Old Building x $5.00 $ Electric Water Heater x $5.00 $ GAS FITTING FEES: lst 3 fixtures x $3,00 $ Additional Fixtures x $1.00 $ Gas Range to 199,000 BTU x $10.00 $ REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE $ REINSPECTION FEE ($10.00) Job Address /0 .1117W- T1� W1411 Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all +cork in strict accordance with the City Codes and rulings of the bepartment of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct / Fridley, Mn. Tp/^/t�Py %% , 197* OWNER i%U � /P /+� AI RAIt7 tJ S C /y KIND OF BUILDING W®D%% /C�jjp✓/ USED A5 PLA) F'LL / .✓� TO BE COMPLETED ABOUT _ TP A/J 0 I y ESTIMATED COST OLD )NEW BUILDING PERMIT NO. ROUGH INSP. Date FINAL INSP. Date PERMIT NO. rixp Company r Signed By R i/-Qyts� Tel. No. O—.S%.72- fr' APPROVAL FOR PERMIT r419 MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE [� .__-__'_--_ �� _-_� ----- ' ) | | ( �-_J of Fridley SUBJECT o 1547 AT THE TOP OF THE TWINS BUILDING PERMIT rpCity RECEIPT NO. `y ______ COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. �� r PROTECTIVE CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 9/24/79 JOB ADDRESS 40 - 64th_ Way N.E. I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4,5 15 Fridley Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lavern Dornbursh- 40 - 64th Way N.E. 571-3853 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION] ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Finish basement and install chimney for free standing fireplace 9 CHANGE OF USE FROM TO STIPULATIONS SEPERATE PERMITS REQUIRED FOR WIRING, HEATING, Pi,UMOING MQ 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 SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $2,000 $1.00 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- $12.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $13.00 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)WHEN ('� r PROPER Y VALIDATED THIS IS YOUR PERMIT SIGNATURE OF OWNER I IF OWNER BUILDER) (DATE) BLDG IN • CITY OF FRIDLEY • APPLICATION FOR RESIDLNTIAL BUILDING PERMITS f (New, Alterations, Additions, or Repairs) , OWNER: EPA/ �� �Pn7 �� S c l-� . BUILDER: - 5.19/j-?& ADDRESS: L1D — 00 E ADDRESS: TEL NO: S 71 TEL NO: - Construction Location . - STREET NO: U STREET: (o T� L�J� Y /l% •..< LOT: BLOCK: l ADDITION: /�2l E P'9 1,C K 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 f/nl/ S4 64 SfMIFKgront: Depth: • Height: Square.Feet: Cubic Feet: q%Front: Depth: Height: • Square - Feet: Cubic Feet: Type of Construction: Estimated Cost: $ 02, D o o,,, 9b Be Oc)mpleted: / fJ D A) E�/EfI 0 ,C' ole Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE REVERSE SIDE OF SHEET . The 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, and hereby declares that all the facts and representations stated in this application are true and correct. DATE: C/_ - a ?` '75 SIGNATURE:. Stipulations: INCIDENT REPORT FRIDLEY POLICE DEPARTMENT TH F S REPORTED BY O I q� 7 y ISN U0C DISP ADDRESS PHONE CFS INC ARR JUV OFF PROP REPLACEMENT VALUE VALUE OF DAMAGE. j VALUE RECOVERED. eo,SUSPECTIS) OR DESCRIPTION TIME OF ARREST N 2 WITNESSES ADDRESS PHONE DOB 2. DETAILS OF INCIDENT. ADDITIONAL REPORTS: DAY w DATE REPORTE �%� TIME RECEIVED TIME ARRIVED TIM9 COMPLETED DATE OCCURRED TIME OCCURRED NRR. - radio P - phone PLACE OF OC URRENC� RID / L A alarm I in person NAME O C NICTIM Y - visual HOME ADDRESS / z, � �D �G PHONE M - mail �)/ �� 5l " � �_ ( T - other TH F S REPORTED BY O I q� 7 y ISN U0C DISP ADDRESS PHONE CFS INC ARR JUV OFF PROP REPLACEMENT VALUE VALUE OF DAMAGE. j VALUE RECOVERED. eo,SUSPECTIS) OR DESCRIPTION TIME OF ARREST N 2 WITNESSES ADDRESS PHONE DOB 2. DETAILS OF INCIDENT. ADDITIONAL REPORTS: 19 SUBJECT PERMIT NO. City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT 22459 i RECEIPT NO COMMUNITY DEVELOPMENT DIV. _ U PROTECTIVE INSPECTION SEC. r 5 Sd NUMBER REV DATE PAGE OF APPROVED By CITY HALL FRIDLEY 55432 612-571-3450 910-F15 4/28 94 JOB ADDRESS 40 64 Way NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4,5 15 Fridley Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lavern/Betty Dornbusch 40 64 Way NE 571-3853 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. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (Tear -off) 21 Squares 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must meet 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 SQ. 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 NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. 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 $1 575 $.79 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 OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $37.00 W Fire SC $1.58 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FAE $39.37 / SIGNATURE OF CONTRACTOR OR ORIZED AGENT A (DATE) WH N P Y VALIDATE THIS IS YO R PERMIT BLDG IN SATE SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) 19 NEW (( Effective 1/ 1 /94 ADDN CITY OF FRIDLEY ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2d55b Building Permit Application Construction Address: ---V0 - `i TN. /0' E- , -- - - - - - --- --- Legal Description: --- 110-15 -p _ 5(���,��/ Owner Name & Address: )AVER -1- 8,- i TY 3au S'f 4 A-6<1 t Wel. # Contractor: 6 u3 A) MN LICENSE # Address: m .E - 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 With gt/Ground Sq. Ft. OTHER: A -C- ` Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: K ,E -Poor 90 O S.f ,&6 R 06-E Estimated Cost: Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ r 11 Tel. # DATE: - = APPLICANT:v-�r,L Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY $ , Ob Fee Schedule on Reverse Side $ .001 of Permit Valuation (1/10th%) $ $.50/$1,000 Valuation $ $800 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 [ ] S 393 7 CITY OF FRIDLEY INSPECTION DIV. Effective On March 1, 1996 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES �'AA� JOB ADDRESS 4 -/11�� - 1�� Alv� 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 - ®'00 rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 30.00 $ J7 representations stated In this application are true and correct. (Side Vent - Fill Out Back) _-- _ ,1996 Gas Piping (Needed with new furnace) $10.00 $ OWNER Gas Range - $10.00 $ BUILDING USED AS Gas Dryer $10.00 $ *Air i..�N a4�1ka ESTIMATED COST PERMIT N0. 4>2 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 Circle One (Steam) (Hot Water)arm Al Trade Name Size No. �355'ir� z d Commercial/Industrial BTU hQ00D HP EDR 1.25% of Value of Appliance or Work $ Fuel Total Connected Load State Surcharge .50 Burner Trade Name Size No. 5 TO BTU HP EDR TOTAL FEE HEATING COMPANY BLAINE HTr. A/C & ELECT. INC. 13562 CENTRAL A14E FI.Es MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION ANOKA, MN 55304 REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 Signe y Tel No.d� PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr Approved ByRough-In Date Final Date"/S' *Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE R STACK VERIFICATION ON written permission from adjoining property owner. REPLACEMENT FURNACE Remarks: List ALTERATIONS Bein Done: HEATING CO: Signed By: Date: W. BLAINE HTG. A/C & ELECT. IN - 13562 13562 CENTRAL AVE. N.E. ANOKA, MW 55304 CEMWiEY 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 (,� 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: List ALTERATIONS Bein Done: HEATING CO: Signed By: Date: W. BLAINE HTG. A/C & ELECT. IN - 13562 13562 CENTRAL AVE. N.E. ANOKA, MW 55304 rj SUBJECT NO. City of Fridley -274 3 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. _ COMMUNITY DEVELOPMENT DIV. v PROTECTIVE INSPECTION SEC. r NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 10/9/96 10B ADDRESS 40 - 64th Way N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4, 5 15 Fridley Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Paul & Gudrun Mattson, 40 - 64th Way, Fridley, MN 55432 586-0097 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Paul & Gudrun Mattson (same as above) 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residence 7 CLASS OF WORK JJ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct deck. 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan VARNING 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 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 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 $656.00 State SC $.50 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- $26.c50 Fire SC $.65 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE $27.65 SIGGN,�ATTURE OF CONTRACTORR-ORR,,AUTHORIZED AGENT HEN PRAOP/ERLY ALI DATED THIS ISYOUR PERMIT q /'yIDATEI Q�P SIGNATURE OF OWNER IIF OWNER BUIL.ERI IDATEI BLD INSP GATE rj NEW [ ] Effective 3/1/96 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress: yo -- 6 y" W'4 Y Legal Description: GnT y �tia S, c3G�c�c �S �,e,pc�Y Aka -f -'- Owner Name & Address: a i, n 1*7 77--So.J Tel. # 5R6 - oo l 7 Contractor: Address: MN LICENSE # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Tel. # LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length /y Width5 °� Hgt/Ground o g Sq. Ft. `77 OTHER: Comer Lot (] Inside Lot [ ] Type of Construction: (e cob Ft. Yd Setback Side Yard Setbacks Estimated Cost: $ j e:�z54� . Ob Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: DATE: APPLICANT: Permit Fee $ �. SU Fire Surcharge $ �o s State Surcharge $ , 50 SAC Charge $ License Surcharge $ Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $ .41 STIPULATIONS: Ft. + 6 Ft = Ft x $ Tel. # CITY USE ONLY 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 $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] rDl ELAN, FIELD & NOW_AK SURVEYORS 28Z9 HARRIET AVE.4EN F MINNEAPOLIS, MINNESOTA CERTIFICATE OF SURVEY For Z1PCO, INC, f ... � A DESCRIPTIONS 44. 3 �. 5, Block and 4 5 Lots t , u Fridley Park. ij Scalps I* — 301 r - i i J We hereby certify that this is a true and correct representation of a survey of the boundaries of the land above described and of the location ofall building4 if any, thereon, and all visible encroachments, if any, from or on said land. �„ .. 1964 ry.:G!`�N,_.F i E L D b NOWAK So 100. h �v 1; al Apt 0�� Railpost Spacing = 72 in. o.c., Baluster Spacing — 4 in., Toe Spacing = 4 in., Railing Height = 36 in. Star I: Rise = 6 in., Run = I1 in. Stair 2: Rise = 6 in., Run =1 I in. Specification IS( r. dFr J' r X ` b /l p * Ask For A Construction Detail Sheet Before You Begin Your Project ll ovc# SPACING ,1 nv\ S Y K TO 0A lei -fe`t� See the Specification Sheet for More Details SUBJEeT PnMIt NO. City of Fridley 31274 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. i ♦ _____ COMMUNITY DEVELOPMENT DIV. V INSPECTION SEC. � /7-2 r PROTECTIVE 1 NUMBER REV DATE PAGE Of APPROVED By CITY HALL FRIDLEY 55432 �.j 612-571-3450 910415 8/2/00 JOB ADDRESS 40 64 Way NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4,5 15 Fridley Park SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Paul Mattson 40 64 Way NE 586-0097 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Window Lite Home Improvements 8400 89 Ave N, Brooklyn Park, MN 55445 20039258 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 425-2227 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW ❑ ADDITION O ALTERATION? REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Replace 11 windows 9 CHANGEOFUSEFROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Permit Inspection Cards Will Be Mailed 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 SQ. 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 $5.40 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $10,800 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- $195.25 Firo SC $10.80 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOT FEE Lice C $5.0 $216.45 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT iDATE, EN PROP V ALID E THIS IS XQUA P MIT r S-GNATURE OF OVVNERnF OWNER BUILDER, iDATE, L IN_ gAif NEW [ ] Effective 1/1/99 ADDN [ ] CITY OF FRIDLEY G ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: n-_L14gA )a -a / c, P(`i a(Lj M— Legal Description: Owner Name & Address: AL& (!'1a+(-san �qq-A, LZo-g pf,. Tel. # J-96- DD 9Z Contractor:() ;�(A) Ll *a & au- O9•Yn �9 r o +� �m�n-F5 MN LICENSE # 0700,3 902 ,P Address: $��pp - q �'�- ,� /�p . �Br�oK(-, `Pat- mA1,55'W5el. # 5 =baa 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: Construction Type: Q imated Cost: $ Y00, 0 C) (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: �% APPLICANT: am , i A Tel. # 4Z,5-2 2- Z Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control $ 195 -"2s - Park Fee $ Sewer Main Charge $ TOTAL $ 07 . ' CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1050 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 [ ] STIPULATIONS. � i.� CITY OF FRIDLEY BUILDING INSPECTION -SO O'�C Effective 4/1/2004 6431 University Ave NE d �� Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION 763-572-3604 FAX 763-571-1287 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer JOB ADDRESS Fee Total � � Al Owner $35.00 $ Building Used As I el 4 - $10.00 $ ESTIMATED COST t. �cJ G PERMIT NO $10.00 $ $10.00 $ *Air Conditioning -AII Sizes $25.00 $ All Other Repairs or Alterations (List on Back) 11/6 of Value of Appliance or Work $ Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater on work less than $500.00 Commercial/Industrial/Institutional 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/IndustriaVinstitutional State Surcharge TOTAL FEE REINSPECTION FEE $50.00/HOUR DESCRIPTION OF FURNACE AND BURNER # of Heating Un Trade Name BTU Fuel ewe Burner Trade Name BTU _ HP EDR Total Connected Load HP Size No. EDR (Warm Air) 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 $ —1r and rulings of the Building Division, and hereby declares that all the facts d representations stated in this application are true anJd correct. $ . 50 HEAT G CO $ -qy _10137'_ *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE 7402 Washington Avenue Eden Prairie, MN 55344 941-1044 Tel# ` O9, -d FAX # Ce ®'� �® Date �7 /lld-- Approved bbyJ �/J Rough -in Date Final Date w FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacina 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 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 existina 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 ventina 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( ) 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 ®15&, `-!® HEATING CO: Signed By: N c 60 /1.1-Z Date Cos-- 006 ,3 0 NEW CITY OF FRIDLEY p [ ] 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� d-1 61A�� IfA i Legal Description: Owner Name & Address: d Tel. # .761 <La Contractor. 1 Ae MN LICENSE # alb, ,? .5-4 �� 3,-5-1Address: �® 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: Construction Type: & 5 Z ,�2 f Estimated Cost: $ /O, 3 /x , 1:9 Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ —=$ DATE: o' ` APPLICANT: ��/—"1'el. # Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge $ q Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1450 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] TOTAL $ STIPULATIONS: Building MECHANICAL Permit No.: ��� - -- Inspections div RESIDENTIAL APPLICATION Received By: 7.63-572-3604 CITY OF FRIDLEY Date Recd: i- - DATE I - l0' YOUR E-MAILDRESS SITE ADDRESS 4o I' THIS APPLICANT IS: 13 OWNER PCO CTOR PROPERTY NAME: �PCI-V �G OWNER/ ADDRESS: O CITY i` r c STATE•MLXIPC TENANT PHONE: -1 (-3 - � (o - ®Uq D CONTRACTOR COMPANY NAME: CENTERPOINT ENERGY SUBMIT A COPY OF CONTACT PERSON: JOANN ZINIMN YOUR STATE LICENSE WITH STATE LICENSE # EXP DATE ADDRESS: 13562 CENTRAL. AVE HE CITY ANOKA STATE ENZIP 55304 APPLICATIONPHONE 763_757-6202 FAY 763-757-6701 PERMIT TYPE 9 )(SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE ❑ NEW XREPLACEMENT ❑ ALTERATION/REMODEL TYPE OF WORK: DETAILED DESCRIPTION OF WORK S cxA\ )Lr, PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 =cost of labor X.05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)14 .2 MFG: C-0- MODEL: aLf K P A 5 SIZEBTU Equipment Installed MFG: MODEL: SIZE/BTU T— MFG: MODEL: SIZEIBTU FIRLACE (GAS) $15.00 GAS RANGEIOVEN $10.00 1A/C $25.00 —EP NEW GAS GRILL $10.00 AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 -BOILER $35.00 UNIT HTR $10.00 $35.00 _FURNACE —GAS _CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00 VENTILATOR $15.00 DUCT WORK $10.00 GAS PIPING $10.00 mo.. . ,•' R.. 1 '. tlY, ' .t. ".;e... .s 1 i ..ail-, A.}.., �. w ..t Permit Fee $ Number of fixtures @ $10.00 x $10.00 $ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $25.00 x $25.00 = $ 05 , CO TOTAL DUE $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 Total = $ P5 -SO 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 in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans. SIGNATURE OF APPLIPRINT NAME ROGER lIOFFHEIN DATE LAN � YIVV,1alJ� •.if..":. _ .. _ ....r.w ,...« 1"r.E .- City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 T A tr. •7/'1 Z'fNn AfN"P7 w - REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMES/ADDITIONSEXISTING HOME ❑ MAKE-UP AIR REQUIRED FOR NEW/EXISTING HOMES 1. Combustion Air (See note below) a. Oil or solid fuel IMC Chapter 7 with MN Amendments . b. Natural Gas or Propane/]FGC Chapter 3 with MN Amendments 2. Make-up Air (See note below) a. IMC Chapter 5 with MN Amendments 3. Venting a. Gas appliances IFGC Chapter 5 with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooling load per room a. Required on new construction IMC 1346.0312 5. Ventilation a. Per MN Energy Code 7670 or 7672 6. Duct Design Per IMC 1346. 0603.2 .a. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make up air, calculations CenterPoint. Energy October 12, 2006 City of Fridley 6431 University Ave NE Fridley, MN 55432 13562 Central Avenue NE Anoka, MN 55304 Please cancel the permit and send a refund, if applicable, for the following: Paul Mattson 40 64th Way NE Fridley, MN 55432 Permit amount: 25.50 and 20.50 Permit number: 2006-01260 and 2006-01259 The job has been cancelled. If you have any questions, you may contact me at 763-757-6202. Thank you, Katie Schlundt Administrative Assistant CenterPoint Energy 13562 Central Ave NE Anoka, MN 55304 CITY OF FRIDLEY PERMIT NO.: 2006-01260 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 07/10/2006 572-36U4 FAX: (763) 571-1287 REPRINTED ON 10/16/2006 ADDRESS : 40 64 WAY NE PIN : 153024410024 LEGAL DESC : UNAVAILABLE : LOT BLOCK PERMIT TYPE : HEATING - FIXTURE BASED PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : AIR CONDITIONING NOTE: H/O:763-586-0097 CONT: 763-757-6202 INSTALL A/C CARRIER MODEL: 24APA5 14 SEER 2 TON # A/C UNITS APPLICANT CENTERPOINT ENERGY 13562 CENTRAL AVENUE NE ANOKA, MN 55303 (763)757-6202 MATTSON PAUL C & GUDRUN 40 64TH WAY NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of worl will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date 1 AIR CONDITIONING FEE 25.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 25.50 PAID WITH CHECK # 8109 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY PERMIT NO.: 2006-01259 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 07/10/2006 571-36U4 VAA: ( 763) 571-1Z5_/ REPRINTED ON 10/16/2006 ADDRESS : 40 64 WAY NE PIN : 153024410024 LEGAL DESC : UNAVAILABLE LOT BLOCK PERMIT TYPE ELECTRICAL PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ELEC SERVICES, NEW NOTE: CALL FOR ROUGH IN AND FINAL INSPECTION H.O. PHONE #763-586-0097 CONT: 763-757-6202 ELECTRIC PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE A/C RECONNECT ENTER ELECTRICAL FEE 20 APPLICANT CENTERPOINT ENERGY MINNEGASCO 13562 CENTRAL AVE NE BLAINE, MN 55304- (763)757-6202 CA01796 OWNER MATTSON PAUL C & GUDRUN 40 64TH WAY NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of wort will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date, ELECTRICAL PERMIT FEE 20.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 20.50 PAID WITH CHECK # 8109 ECOPY SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.