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PRE 2010 DOCSVillage of Fridley, Minn.. BUILDING PERMIT Office of INSPECTOR OF BUILDINGS owne Olt, Architect Fridley, Minn., Builder LOCATION OF BUILDING -390 Lot No. Street Part of Lot Block—W3 Addition or Sub -Division DESCRIPTION OF BUILDING Front± Depth I W 0 -_ Height— Stories manner of Construction mo "'if Ow, 40 To be used as To be complete Estimated Costi ww'Y 1 Ili Permit to hereby glinted to ;1 r 4 e4 r v the buRdinLr described in the above statement. This permit is granted upon the express caditlon that the person to whom 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,$11=., regarding the construction, alteration, maintenance, repair and moving of buildings within the city lbxd s, and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. Inspector of Buildings. II II AGREEMENT AND SWORN STATEMENT In consider�iiion of the issue and delivery to me by the Inspector of Buildings of Fridley of the above permit, I herebv agree to do the proposed work in accordance with the description above set forth and according to the ns of the ordinances of Fridley, first duly provisions and, being f p sworn, I hereby 4tate and say that the f; stated by me and contained in the., above permit are true as therein fated. /* Subscribed day of swornto before me at Fridley, Minnesota, A.D. 19 9 SUBJECT O. City of Fridley'263 19 AT THE TOP OF THE TWINS BUILDING PERMIT rp _____ COMMUNITY DEVELOPMENT DIV. i fr _ f PROTECTIVE INSPECTION SEC. 1 . � NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 ti..__.11: '•� 612-571-3450 910-F15 6/23/98 JOB ADDRESS 390 66 Avenue NE I LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 2 3 Rice Creek Terrace Plat 2 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Laural Sherman 390 66 Avenue NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Construction USA Inc 9140 Lexington Ave Lexington, MN 55014 785-2435 20131506 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 O ALTERATION _❑ REPAIR 0 MOVE ❑ REMOVE X 8 DESCRIBE WORK Reroof House & Garage (19 Sq) 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 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 1 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 $1,584 $.79 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. $51.25 Fire$1.58 STRUCTI0 OR THE PERFORMAN E OF CONSTRUCTION. AC Q .PLAN CHECK FEE TOTAL Licen $5. 0 58.62 SI N TURE OF CONTRAC OR AIJTMORIZEDAGENT IDATEI_ P P _ BLDG SP LIDATE T SIS V �R PERM T f +1 99 GATE SIGNATURE OF OWNEROF OWNER BUILDERI (DATEi NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: Legal Description: Owner Name & Address: 0 UK Tel. # Contractor: 0 � � �l = �� e MN LICENSE #—',U Address:. fw � _ �C''Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF RUPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. _ OTHER: cP ��o� ��� 7 -F4 Construction Type: Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft.+ :Ft= Ft x $ _ $ DATE: APPLICANT: Tel. # CITY USE ONLY Permit Fee $ 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 [ ] TOTAL $ STIPULATIONS: A QtTY OP'FRIDLEY INSPECTION DIViSION Effective On January 1, 2002 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS S?C) 66 ,4a RATE SCHEDULE ". OWNER ZA-� R Si�G'2ftiFl-� Residential Rate TOTAL Furnace Shell and Duct Work, Burner - BUILDING USED AS RL 4-4 NC Also Replacement Furnace $30.0 0 (Side Vent'- Fill Out Back) $! oe ESTIMATED COST PERMIT N0: Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) f DESCRIPTION OF FURNACE AND OR BURNER - Gas Range $ 10.00 $ :' No: of Heating Units Circle One (Steam) (Hot Water Warm Air Gas Dryer $ 10.00 $ Trade Name RU v -b Size No. - BTU HP EDR *Air Conditioning - All Sizes $ 25.00 $ Fuel Total Connected Load All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No. 1% of Value of Appliance or Work $ BTU HP EDR Commercial/Industrial 1.25% of Value of Appliance or Work $ 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 an State Surcharge $ .50 rulings of the Building Division, and hereby declares that a•If, the facts and representations stated in this application are true and`correct. . TOTAL FEE $`� X:) AVENUENO.�_ � 8812147R0DR'ITRkCT®RS. �] WRTE 'L ��" CI$Y TAL, MN 55422 MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE Signed TEL # FAX # REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in aside yard without Approved By � Rough -In Date Final Da(,10(i written permission from adjoining prop ertowner. a THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED When re In acing an existingf urt anre, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No ( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and 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 comb istinn air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to install a n _w -om6 ,ction air it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When installing a new ventina nyc Pm, 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 Fumace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes( )No( ) Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type S -t 6v Ll cam- ,Q 0 A -d-15- 6--t-J HEATING CO: Signed By: Date : Z! 2_ wd HOUSE HEATING TEST RECORD ,�/A ADDRESS APT. FLOOR CITY SUBURB 'r^// OCCUPANTXIAW,&-14` OWNER HEAT LOSS DATE HTG. INST. SOLD BY ! INSTALLED BY Electrical Work By Gas Line By TYPE OF HEAT GA FA HW STEAM SPACE HTR. _UKIT HTR. OTHER GAS DESIGN CsIsmXf#1 ijlh1 MAKE 144wf4ez MAKE Model 1141Z,4 Model SerialMax. INPUT `f�%®a�� MAK OF BURNER E BTU Rating OF FURNACE Model CONTROLS THERMO TAT Heat Plug —G Vent Size a Valve w KIND OF LINER SIZE NON Limit -� Limit Setting Fan Setting Pilot Type Pilot Make 4V_,& Pilot Model Draft HoodRegulator Filters Size umber Chimney Location Inside—Outside Chimney Construction Smoke Pilot Timing 4-- + --x Draft L.W. Cut Off Pressure 3- Percent CO2 Input CFH Percent 02 Stack Temp. lV�d Percent CO Form 235 Door Date Bomb Wiring 11/ �,g Test Tagg/ Pressure Lighting Inst. Tested —�" ® 2 Company Testing Name of Tester Building PLUMBING hermit No.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604CIT,'Y OF FR1 DLEY Date J U DATE Tune 8, 2007 YOURE-MAIL ADDRESS wnelso�laLsonplumbing.com SITE ADDRESS 390 - 66th Avenue NE THIS APPLICANT IS: © OWNER NCONTRACTOR i PROPERTY NAME: Laurel Sherman ADDRESS: 390 - 66th Avenue NE _ CITY Fridley STATF- ISI zIP 55432 OWNER/ TENANT PHONE: 763/571-1125 CONTRACTOR NAME: Larson Plumbinq, Inc. STATE LICENSE N 3341 PM EXP DATE 12/31/2006 SUBMIT A COPY OF YOUR STATE ADDRESS: 3095 -162nd Lane NW CITY Andover sTATEMN zip 55304 LICENSE WITH PHom 763/427-7680 FAX 763/427-9448 APPLICATION PERMIT TYPE M SINGLE FAMILY D TWO FAMILY ❑ TOWNHOUSE TYPE OF W 012K: o NEW C1 REPLACEMENT DETAILED DESCRIPTION OF WORK Water Heater Replacement 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) BATH SINK/LAV —FLOOR DRAINS —SHOWER _ WATER PIPING _ GAS PIPING (AM cmLICEMP) _ SWIMMING FOOL—WATER SOFI'NER ($35) —BATHTUB CLOTHES WASHER_ KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($I5) _ DISHWASHER _ LAUNDRY TRAY X WATER HEATER ($35) FOR IRRIGATION _ WATER METER —OTHER ' �;.'t :€. ;i•:'. :�fii:':.^5..,^f`.a`:pr��aj: 3?c:rT.tk .X�• :. �,. ..,`, fs._ _�', TS'c �y •YW� a; .�y. ,f,�i>.. .,:�..,;.r#.•&?J;n,u._�r;:7C?.,�4:_' �P'. ��'D�O��'.i�.'IJ:I T.vL�1'�'��iti�atSVV�+ +..1.•+.�ll;x'!�.L•...'lf���'�`;i•�. �4!,®�..{Si. • .,fry ....r... n>!."Si? r' at;5,$F, F7.i. ..ur�nr. W.. Permit Fee $ X5 00 Number of fixtures @ $10.00 x $10.00 = $ Surchar •e .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ 35.50 Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 Total = $ 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 ofall wok which requires review and approval of plans. SIGNATURE OFAPPLICANT .... PRINT NAME Wendy Nelson DATE 6/8/07 U— ' .'�u` . .' y 'u ,i'.. _ a . i' 4•.1 Y ° i)".�' f`u. .rrc�sr,,"i do p� City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 )0%