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PRE 2010 DOCS- PERf" • - - Q g�yf� 7�rM1y Offi�e ®1. } - T y t y�✓s�x I}, +Y Arch tec � I y d� r 1 ey, fin,.;_ r LVw/A as I `L46-4 - mo I ,p oL iJVt�. Lotlocilc' n �+�:%V�#• 'I Addition or Stals-I?ivisioDr ' - ♦�, g'ront II Dep , F Rei t Stones MBn er:oi' Conjtruttibn _ Z`o -be nspcl a Ta be igirn ted I" *� �a ri 7sti�mated o < '" +EIO . - I Permit ie he$i�y ted to the by cUn " ia in i�tlie: above statement. Th9s p�§rm�1t _W granted upon the euP ¢.is a tioa that the-'person to. whom itis gx�z�ted, °moi his agents, employees acid iRoskmen, : in aft the work 401264n, naaCes..Olt,Fley,' anti and ugoni Said bttiiding, or',anj art thereof,,slaalI colrPorin, is all respects to the' ordi- Mwon, the coustrueiion, aitet%t%ts,mniateizanre 'repair. anal :moving of. buildings. within the ci$j►I limi said and this pexxijit maq be revol�8d at �Y ttaima upon violatican'of any. of the provisions or,01 ;aM spedor 8uildffigs' . �f ,of I ,A7�VilrA'4 IJALJ1' 1'JS.�1LV� ra 78 co era I' n of the his ae -and delver to sate til'O ��ect6r of �tulldta� of �1i�kle�r of the above t; .Tagg I ;hereby age to''do the propoi�ed i� �,ctordance.'t�tith the description- '• above set fb#th .�oz'� aGCording to the provi ions 'Of k iae brdinanees of Gley, and, being flrst,duly s®vo hereby to atiaad say',: that the.fabts.state,by gne,rd eotained in the'above perazt are true a_ s them �Subscrt'bed and JV onto befz�re'ffie at+'riley,:ot; fiia �. day O T--...ICA D. - �i�P� � 'i o, f 51.1 N { h y, c£ ,y'!i r ^ ( JSp .x j• b l�"^, ri f - a i d' I ar n - 9 � •{ 4fi r7C i` , :(' V N° 913 n U village of Fridley, Minn. BUILDING PEPOM ^m-- G°rOR OF BiTiLD"1q%X0 U Fridley, Minn..%•�� 'c=�°cj„ -�,� AtT. - 18 Builder LOCATION OF BUILDING No. /1 57,11 Street—1 C" 6" �&�--c Part of Lot Lot !!Block Addition or Sub -Division G DESCRIPTION OF BUILDING Frontes Depth. -F Height Stories Manner of Construction_ To be used as 61'? ,-- ``'X'tr To be completed Estimated Cost Permit is hereby granted to�Z:�°%Y the building " described in the above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work done in, mound and upon said building, or any part thereof, shall conform in all respects to the ordi- nances of Fridley, Minn., 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. � ~-., '� ` �• ZM ..c, inspector of Buildings. 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 and according to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby state and say that the facts stated by me and contained in the above permit are true as therein stated. r Minns before me at Fridley, sofa ubscri ed andsworn to e , day of/.-, A.D. 0 • di City of Fridley, Minn.. BUILDING PERMIT .: No 6407 Builder _ _-- Address L CAT N OF BUILDING NO. Street i Part of Lot Lot ---- __ Block Addition or Sub -Division Corner Lot _ Inside Lot — Setback Sewer Elevation Sideyard Foundation Elevation DESCRIPTION OF BUILDING To Used as• t — Depth Height . _ Sq. Ft. Chi. Ft. Front DepthHeight Sq. Ft. Cu. Ft. Type of Construction Est.. '^fit __ _ To be Completed In consideration of the issuance to me of a permit to c the proposed work in accordance with the description above ordinances of the city of Fridley. In consideration of the payment of a fee of the in permit is hereby granted to I agree to do provisions of 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, Bliinnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any tune upon violation of any of the provisionsof said ordinances. ,,-% -I A / 1 NOTICE. ffib psemft dose not corer the construction, hutaWen for whdng, phnnbing, gas heating, sewer or water. Be sura to see the BuihUng hepeetor for separate permits for these hone. No 6407 Builder _ _-- Address L CAT N OF BUILDING NO. Street i Part of Lot Lot ---- __ Block Addition or Sub -Division Corner Lot _ Inside Lot — Setback Sewer Elevation Sideyard Foundation Elevation DESCRIPTION OF BUILDING To Used as• t — Depth Height . _ Sq. Ft. Chi. Ft. Front DepthHeight Sq. Ft. Cu. Ft. Type of Construction Est.. '^fit __ _ To be Completed In consideration of the issuance to me of a permit to c the proposed work in accordance with the description above ordinances of the city of Fridley. In consideration of the payment of a fee of the in permit is hereby granted to I agree to do provisions of 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, Bliinnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any tune upon violation of any of the provisionsof said ordinances. ,,-% -I A / 1 NOTICE. ffib psemft dose not corer the construction, hutaWen for whdng, phnnbing, gas heating, sewer or water. Be sura to see the BuihUng hepeetor for separate permits for these hone. u SUBJECT PER City of Fridley 15 216 AT THE TOP OF THE TWINS B U I L D I N G P E R M I T _ rp R O. � • COMMUNITY DEVELOPMENT DIV. �><: ------ INSPECTION SEC. p r � � PROTECTIVE --'1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 15/25/79 JOB ADDRESS 1630 - 66th Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 3 Moore Lake Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Vanderwerf 1630 - 66th 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. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION Lk ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof structure 9 CHANGEOFUSEFROM TO STIPULATIONS goof can be second but not third roof. Install ridged galvanized valleys. 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 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 $1,000 $.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- $7.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $8.00 SIGNATURE OF CONTRACTO OR AUTHORIZED AGENT (DATE) I - WHEN PROPERLY VL]DATED THIS IS YOUR PERMIT BLDG INSP I DATE / `SIGN TURE OF OWNER IIF OWNER BUILDER) (DATE) u CITY OF FRIDLEY APPLICATION FOR RESIM-:14TIAL BUILDING PERMITS (NEW, ALTL=RATIOIJS, ADDITIONS, ORRL"PAIRS) OWNER: "To io -\� AC] f Lk, e- r S AUILDER: Address: 110n Q'1 lig . N C Address: Tel. No.: No.: Street: LOT: BLOCK: ADDITION: CORNER LOT: INSIDE LOT: SETBACK:' SIDEYARDS: Applicant attach to this form T<vo Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: PrT c//' Front: Depth: Height: Square Feet: Cubic Feet: 'Front: Depth: Height: Square Feet: Cubic Feet: Type of Construction: Estimated Cost: $ To Be Completed: 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. See reverse side for additional information. DATE: " 2S- 9 SIGNA`T'URE: V Stipulations: - so KOO 97-h-879001 CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric Water Heater GAS FITTING FEES: 1st 3 fixtures Additional Fixtures Gas Range to 199,000 BTU REPAIRS $ ALTERATIONS First $100.00 each add. $100.00 or fraction x $3.00 ' x $2.00 $ >, w $ x $5.00 v x $5.00 v x water o a $7.00 $ m $5.00 $ x {y�,�, a m M $4 04 w � Heater trU N k C yy C x C k 3 O U .11 8 x U' U+ C H 6 • w y + M -4 U M a r0 a 'n ro 3 O 0 W x U, .i0 w m C M 7 ro a 3 M t� o as 'lec 1st 1 ew lin 3r hir e 2nd 3rd 4 th (R) a Future Connection Opening Connected with Sewer M a New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric Water Heater GAS FITTING FEES: 1st 3 fixtures Additional Fixtures Gas Range to 199,000 BTU REPAIRS $ ALTERATIONS First $100.00 each add. $100.00 or fraction x $3.00 '$ x $2.00 $ x $2.00 $ x $5.00 $ x $5.00 $ x $10.00 $ x $7.00 $ x $5.00 $ x $5.00 $ Job Address 1633 xz 66 A -- 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 work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facL•a and reprosontations statod in this application are true and corroct Fridley, Mn. 7-3-79 , 19 OWNER _ -- - WANDE'TWERF KIND OF BUILDING frame USED AS res. TO BE COMPLETED ABOUT 7-10-79 ESTIMATED COST 140,00 OLD - NEW BUILDING PERMIT NO. PER14IT NO. Company Signed By MINNEGASCO ROUGH INSP. Date Tel. No. FINAL INSP. x $3.00 $ Date x $1.00 $( (% x $10.00 $ APPROVAL FOR PERMIT $5.00 $ 5.00 $2.00 $ 9_M MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE State Surcharge $ .50 �. ✓n U TOTAL FEE $ • REINSPECTION FEE fain nn% 0 SUBJECT PER . City of Fridley r -17-035 AT THE TOP OF THE TWINS BUILDING PERMIT rp CEIPT NO. • L' - _____ COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r � � PROTECTIVE '--11 CITY HALL FRIDLEY 55432N l UMBER REV. DATE PAGE OF APPROVED BY ----� L 612-571-3450 910-F15 7/7,183 JOB ADDRESS 1630 - 66th Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 3 Moore Lake Park 1st Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Vanderwerf 1630 - 66th Avenue N.E. 571-5382 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Rod Johnson Construction 7835 Gloria Circle 786-0702 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 �1 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 23' x 1716" Addn. & a 24' x 2218" Garage 9 CHANGE OF USE FROM TO STIPULATIONS C7 w gull SEPERATE PERM-ITS REQUIRED FOR WIO G'` dial ��Il local utttittes HEATING.* PLUMEUNG AND,,'91tiks, dafae TELEWOE'ELE:CS LAW REQSY 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 7L 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 $13.30 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $26,600 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE P OVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- RUCTION OR THE PERFORMANCE OF CONSTRUCTION. $179.50 NONE PLAN CHECK FEE TOTALFEE '7 7 44,138 $237.68 `r WHEN PROPERLY LIDA'ED HIS IS YOUR P RMIT S N TUREOFR CTORORAUTHORIZEDAGENT ATEW .y "r � r • JD, BLDG INSP DAT SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI-� Effective Aug. 1, 1981 CITY OF FRIDLEY APPLICATIM FOR P.ESIDERTI& BUILDING PERif ITS (New, Alterations, Additions, or Repairs) OWNER: �'�i ��� �� � �V � BUILDER: dna )/ L & Z A)G ADDRESS: TSA D57 611: ADDRESS: 76; C 12� c �- TEL h0: X71- T3 TEL 110: 7 Construction Location STREET NO: 70 STREET: �� T LOT: BLOCK: ADDITION: 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 CMISTRUCTI.ON Front: 22, Depth: L) ` � � Height: Square Feet: Cubic Feet: Front: `E Depth: a -I z,� )� Height: Square Feet: Cubic Feet: Type of construction: � ff K Estimated Cost: $ 00 7b Be Mr,pleted: % f / Alt. A Alt. S Proposed Driveway Width If New Opening Is Desired: /C $ $ SEE PEVF.RsL' SIDE OF SHEET . Mie undersigned hereby makes application for a permit for the %:.,ork herein specified, agreeing to ao,all work ia: strict accordance with the City of Fridley Ordinances and rulings of the Depzrtment of Buildings, and hereby declares that all the facts and representatiens stated in this application are true and correct. DATE: SIGNATURE.: Stimulations: per- ,og. 6� p.Q, yq. on 7Y CITY OF FRIDLCY Effective Aug. 1, 1981 ' APPLICATIM FOR RESIDENTIAL BUILDING PEW41TS (New, Alterations, Additions, or Repairs) OWNER: osoo ADDRESS: a(-occfg TEL 00: P? 610 - ® goZ 'BUILDER : ADDRESS: TEL NO: Construction Location j C STREET NO: Fcr�' (} STREET: LOT: BLOCK: ADDITION: 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. Front: DESCRIPTION OF CONSTRUCTION Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet: Cubic Feet: Type of Construction: Estimated Cost: $ Zb Be C.brapleted: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: SEE 10VFME SIDE OF SHEET Mie undersigned hereby makes application for a permit for the ♦:rork herein specified, agreeing to do•all work in strict accordance with the City of Fridley Ordinances and rulings of the Delwirtment of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE: e141 In SIGNATUIE: n7 Z 11A Stipulations: Rough Insp. Date Final Insp. 3 - Z - Y'-/ Date Approval for Permit f MINIMUM FEE FOR ANY HEATING PERMIT IS $10.00 PLUS $.50 STATE SURCHARGE Attach stack verification fors with replacement furnace permits *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. HEATING or POWER PLANTS. Steam, Not Water, Mart Air- No. Trade Name size No. Capacity Sq. Ft. EDR BTU HP Total Connected Load BURNER - Trade Name Capacity Sq. Ft. EDR Kind of Fuel Size No. BTU NP Company S E c B 4� Signed By Tel. No. ( J& Effective Aug. 1. 1981 CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE 6�� /J 1630 cv RESIDENTIAL RATE TOTAL Job Address Furnace Shell and Duct Work, Burner (Also replaeesent furnace) $ 20.00 $ Department of Buildings 6431 University Ave.N.E., Fridley, MN 55432 City of Fridley Gas Piping $ 10.00 $ Tel. /571-3450 (piping needed with new furnace) Gas Range $ 10.00 $ 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 Gas Dryer $ 10.00 $ and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. • Air Conditioning (all sites) $ 10.00 $ Fridley, Minn. ...IL . 19 All Others/Repairs and Alterations OWNER /%arel il/ &.001 - 001 -It i A plance or or of Value of k W It Appliance S //�P / f ��/�'� r�/ KIND OF BUILDING �� o U S �. , COMMERCIAL/INDUSTRIAL USED AS G % �o F it c�)Pen 0 -' �' d e v 64 1%-- 1• of Value of Appliance or Work 10 $ To BE COMPLETED ABOUT v c3 ESTIMATED COST State Surcharge $ .50 PERMIT NO. D OIA NEW BUILDING PERMIT ND. TOTAL rn $1v• Reinspection Fee ($15.00) $ DESCRIPTION OF FURNACE/BURNER Rough Insp. Date Final Insp. 3 - Z - Y'-/ Date Approval for Permit f MINIMUM FEE FOR ANY HEATING PERMIT IS $10.00 PLUS $.50 STATE SURCHARGE Attach stack verification fors with replacement furnace permits *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. HEATING or POWER PLANTS. Steam, Not Water, Mart Air- No. Trade Name size No. Capacity Sq. Ft. EDR BTU HP Total Connected Load BURNER - Trade Name Capacity Sq. Ft. EDR Kind of Fuel Size No. BTU NP Company S E c B 4� Signed By Tel. No. ( J& CITY OF FRIDLEY Effective May 1, 1990 T APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE OC C T nOCTT s T. Furnace Shell and Duct Work, Burner (Also replacement furnace) Gas Piping (piping needed with new furnace) Gas Range Gas Dryer * Air Conditioning (all sizes) All Others/Repairs and Alterations li of Value of Appliance or Work COMMERCIAL/INDUSTRIAL It of Value of Appliance or Work RATE TOTAL $ 20.00 $ $ 10.00 S S 10.00 S $ 1Q.00 $ CIO/_ $ 10.00 $10 State Surcharge TOTAL !EE Reinspection Fee ($15.00) Rough Insp. Date Final Insp. Date Approval for Permit MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00 PLUS $.50 STATE SURCHARGE S E Job Address ILD bO - 4Dt0+,ly RQ0 NY Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 city of Fridley Tel. #571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. N Fridley, Minn. OWNER �f\ Y °cy\AC-c,-,o (--R KIND OF BUILDING `) 1i ` \\ �A USED AS � S ► 80 TO BE COMPLETED ABOUT ens/ ESTIMATED COST \ > -6Q 0/7 OLD - NEW BUILDING PERMIT NO. PERMIT NO. DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Wars Air- No. Trade Nam Size �)� Size No. Capacity Sq. Ft. EDR BTU HP Total Connected Load Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Company 1 1�� \ L L3• Sign Tel. No. *Air Conditioners can not be placed in side yard without written permission from adjoining ne uihbor. Fill out back side for stack verification on replacement furnaces CHIM14EY 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 connected Yes ( ) No ( ) 6. Has Total heating BTU s of All other BTU's TOTAL Remarks Company Signed Ry Date 1* SUBJECT City of Fridley 2AT iPT THE TOP OF THE TWINS B U I L D I N G P E R M I TRENO._COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. �CITY NUMBERREV DATE PAGE OF APPROVED BY HALL FRIDLEY 55432 612-571-3450 910-F15 6/21/94108 ADDRESS1630 66 1 2 Avenue NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 12 Moore L2 SHEET PROPERTY OWNER MAIL ADDRESS ZIP PHONE Paul Ikier 1630 66 1/2 Avenue NE 571-4785 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Panelcraft of Minn Inc. 3118 Snellin Ave S, M ls. MN 55406 721-6628 2179 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 DESCRIBEWORKSiding; soffit & fascia 9 CHANGE OF USE FROM TO STIPULATIONSReplacement of bedroom windows must meet egress code. Smoke detectors shall be installed adjacent to all sleeping areas and in basement. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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. 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$7994 $4.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMITDOES PERMIT FEE SAC CHARGE NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $99.00Fire SC $7.99 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE License SC $5.00 $115.99 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI 1 WHEN PR 4 BLDG )NS Y VA (DATED THIS IS YOUR PERM T MATE SIGNATURE OF OWNER )IF OWNER BUILDER) IDATEI 1* NEW [ ] ADDN [ ] ALTER [�} CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Effective 1/1/93 A-7a-3aD. Construction Address: 1130 — / y 4�r N'5 yzUjj1 .5: Legal Description: Owner Name Address: Pa,� � `� 16,51) - �G a, i A� Tel. # 5_71- V 7S Contraci MN LICENSE # 00 D a ! 7 9 Address: Tel. # 701-66,22 A ch to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: DESCRIPTION OF IMPROVEMENT Length Width Height Length Width Height Length Width Hgt/Ground Corner Lot [ ] Inside Lot [ ] Type of Construction: Approx. -Completion Date: Driveway Curb Cut Width Needed: Sq. Ft. Sq. Ft. T Sq. Ft. Ft. Yd Setback Side Yard Setbacks Estimated Cost: $ Ft. + 6 Ft = Ft x $ (Cost on Back) DATE: APPLICANT: C �j� ,l�D�d,7 Tel. # CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ 7,99 .001 of Permit Valuation (1/10th%) State Surcharge $ f . ®-o $.50/$1,000 Valuation SAC Charge $ $750 per SAC Unit License Surcharge $ 6-0 $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ 11<12 STIPULATIONS: c' ZIAS Ce6e'en City of Fridley SUBJECT � 26460 AT THE TOP OF THE TWINS BUILDING PERMIT r COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. "1 CITY HALL FRIDLEY 55432 NUMBER REV DATE 7/7/98 PAGE OF APPROVED BY 612-571-3450 910-F15 JOB ADDRESS 1630 66 Avenue NE 1 LEGAL LOT NO, BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 3 Moore Lake Park 1st Addition SHEET 2 PROPERTY OWNER MAIL ADDRES$ ZIP PHONE John/Cynthia Vanderwerf 1630 66 Avenue NE 571-5382 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Skyway Quality Homes Inc 8025 Garfield St, Spring Lake Park, MN 55432 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 784-5464 3005 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO, 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW Ij ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 13' x 12' Three Season Porch Addition 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. Before dlgglhg calf tot ° ,� ° stPAMV P ?p41TS all utility locniolt9 ° 454-0002, ° RE9 .W,JRING, yEgT� WIRED FOM REQ1�1RfID BY �AW. t p �l8t 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 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 $4,071 $2.04 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- $99.75 Fire SC $4.07 STRUCTION. PLAN CHECK FEE TO FEE 7-6-OK Z Licens C $5. $110.86 SIGNATURE O CONTRACTOR OR AUTHORIZED AGENT IDATEI EN R%PVALIDT THIS IS YQUR PERM r 7- INSp FATE SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI U4 NEW [ ] E fective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 ( � BUILDING PERMIT APPLICATION _ � ��`�- 4 ConstructionAddress: Al -?O V/6� Legal Description: Owner Name & Address: #A) ✓!/A/D�oplld��Pl= Tel. # S'% 6' -F' 2— Contractor: 5i�YGj/R �/ © f AG17f�- f�D� fS �"oy�• MN LICENSE # Address: ez d zit! Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT i LIVING AREA: Length / Width /a Height Sq. Ft. �•l� GARAGE AREA: Length Width Height Sq. Ft. 7�a DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: ko, Construction Type: 3 5rXS ops 1-901fC I -I Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: -6-,26 -9r APPLICANT: /A � Tel. # Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: 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 [ ] 0�) C�(T`( W19TC K _71m, -NI-11 WELL OR LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring AND BORING SEALING RECORD Sealing a Unique No. H o couriv NameWELL Anoka or Statutes, Chapter 1031 or W -series No. (Leave blank a not knO") Township Name Township No. Range No. Section No. Fraction (sm. i Ig.) Date Sealed Date Well or Boring Constructed Fridley 1 30 24 1.: 1 w N N 1-15-98 of .BWei{ Well or Boring Location Numerical Street Address or Fire Number and Fridley 16i 0 i< Gth Ave. NE, 6 r i d l cy Depth Before Sealing �� ft. Original Depth ft. Show exact Icraof wall or boring Sketch map of well or boring AQUIFER(S) STATIC WATER LEVEL sent®ngid with `r. location, showing property linl6 lines, roads, and buildings. N - 'T- -T- -T- E KQ Single Aquifer ❑ MuitiaquHer '.Measured C] Estimated 5!, ft. below ❑ above land surface WELL/BORING [ Water Supply Well ❑ Monit. Well ❑ Env. Bore Hole ❑ Other CASING TYPE(S) - i f-- T Steel ❑ Plastic ❑ Tile ❑ Other K rrde I nag N�fa � CASING DiameterL Depth Set in oversize hole? Annualar space initially graded? 3 in. from :l to 50 ft. ❑ Yes 151 No ❑ Yes ❑ No ❑ Unknown in. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown in. from to tt. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown ¢R'S NAME PROPERTY Cynthia Vardervierf Proper yawnefs my T g address d drlferem Vmrr wap location address bnditW above. Jdait SCREEN/OPEN HOLE Screen from 60 to 65 ft. Open Hole from to tL OBSTRUCTIONS qN Rods/DropPipe ❑ CheckValve(s) ❑ Debris ❑ Fill ❑ No Obstruction WELL OWNERS NAME Type of Obstructions (Describe) 541 14" d.p. &,yet WN swats wairq address d dllerera than property Donets address indicated above. Obstructions removed? ® Yes ❑ No Describe PUMP Type ❑ Removed U Not Present ❑ Other NELN9iMCAL MATERIAL COLOR HARDNESS OF FROM TO FORMATION 9 act ioxmin lag from nearby well or boring. , eardivla saBrrmEad formation METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE: ® No Annular Space Exits ❑ Annular space grouted with tremie pipe ❑ Casing Perforation/Removal kr. from to tt. ❑ Pertoated ❑ Removed In. from to R ❑ Perorated ❑ Removed Type of perforator ❑ Otlrer GROUTING MATERIALS) Nt clat 5- 65 Grouting Material from to ft yards bags from to R yards bags from to (L yards begs from to R yards bags MOWN, SOW= OF DATA, DFFICULTiES IN SEALING OTHER WELLS AND BORINGS Other unsealed and unused well or boring an property? [:1 Yes 15 No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was seated In accordance with Minnesota Rules, Chapter 4725. The information contained in tlds report is We to On best of my knowledge. Mork We] I Ct)., Inc, 02658 C-�rf-' t Alarms � Urxrtse a Rspbhenon rJo. 7-106-98 Authorized Rjoresentadve SWIsfufe now Tim Chouinard LOCAL COPY IN 139816 � � � � � Arne of Person Sealing Wepor Sortng 2/97 R V -0 su9jEcr City of Fridley 33513 AT THE TOP OF THE TWINS BUILDING PERMIT O • _____ COMMUNITY DEVELOPMENT DIV. �% r � � PROTECTIVE INSPECTION SEC. f/0 14UMBEA REV DATE PAGE O: APPROVED BY i �•� CITY HALL FRIDLEY 55432 .--.� ��'-' L 763-571-3450 910-Ft5 5/13/03 JOB ADDRESS 1630 66 Avenue NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. j 3 Moore Lake Park 1st Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Vanderwerf 1630 66 Avenue NE 763-571-5382 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Renewal By Andersen 1920 Co Rd C W, Roseville NN 55113 651-264-4777 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20130983 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 Replace 7 windows and 1 door within existing openings 9 CHANGE OF USE FROM 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. Caulk and flash all exterior openings. r it Inspection Cards Will Be Mal l®d To Homeowner To Post 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 $5.71 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $10,335 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 nse SC $5.00 $215.76 S-GNATURE OF CON'RACTOR OR AUT.ORiZED AGENT 'DATES WHEN PROPERLY VALIDATED THIS IS Y UR PE MIT _ 11 kC� S-GNATURE OF OWNEROF OWNER BUILDERS iDATE, OG INSo TIATF V -0 NEW [ ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: tp 3 Q -6 Lot -12 Ate.. N r Legal Description: Owner Name & Address: Sp1�Y, �j Q,�g, f �� r _^- Tel. #P3 , 571 53$d. Contractor:; z%xw, MN LICENSE Address: 19 a6 COS&A 1t ooh C. l,J� ��c�scu�t tY1� S� ll� Tel. #(csl •2144 .y"+++ Attach to- this application, a.Certificate of Survey. of -the lot, with the proposed construction drawn on it to scale. DESCRWE R-ON*OF Be-ROVEIV ENT LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Construction Type: Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. Driveway Curb Cut Width Needed: DATE: Z.; -Q Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Ft. + 6 Ft = Sewer Main Charge $ TO TAL $ STIPULATIONS: �, Estimated Cost: $ 10 33 sJcj / Ft x $ = $ Tel. # 9Sa •34,s•lcdq 4- 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 [ ] &a sAg.7 9 Y CITY OF FRIDLEY INSPECTION DIV. Effective April 1, 2004 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT�� (763) 572-3604, FAX (763) 571-1287 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS ( (-PFJ® LUV�l Oi % K(L New Fixtures $10.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $10.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $10.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $10.00 and representations stated in this application are true and correct. Catch Basin $10.00 Rain Water Leader $10.00 DATE: 1+ 20 Sump/Receiving Tank $10.00 Water Treating Appliance $35.00 OWNER n L&)C'&n Water Heater -Electric $35.00 Water Heater- Gas** �_ $35.00 35° �� e , '� erC -A- BUILDING USED AS RI/Q Cse.10-0— Gas Range** $10.00 Gas Dryer** $10.00 ESTIMATED COST )WO � 00 PERMIT NO. Back Flow Preventer Required ( )Yes () No Type $15.00 PLUMBING COMPANY Reinspection Fee $50.00/Hr SIGNED BY TEL N0. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance Approved By Rough -In Date Final Date State Surcharge $ .50 5C� MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST TOTAL FEE $ J OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. "PROVIDE COMMON VENT INFO ON BACK SIDE 315.�3oM0 FILL IN COMPLETELY FOR REPLACEMENT FUEL BU14NING APPLIANCE PERMITS COMMON VENT: VENT CONNECTOR AND COMBUSTIONAIR VERIFICATION When replacing an existing fOrnace, 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( ) 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 ALTERATIONS: (Describe) HEATING CO: Signed By: Date Building BUILDING Permit No.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: DATE [-2J 0(0 YOUR E-MAIL ADDRESS r*, 5 QJ� �`� On �S . On-- SITE ADDRESS Ib3 ® G 6 �` AY l= ! � QE THIS APPLICANT IS: ❑ OWNER RkONTRACTOR PROPERTY OWNER/ NAME: 3 to N r 4 \JAr4O C 1`Z W L ((- T TENANT ADDRESS: I "6'3 (] 6G t- A4E: Id e CITY Ca 1 Ol L---- ` STATEor*'-3 Z PHONE: 7�� .5') • �': �'i �— CONTRACTOR NAME:_ RENEWAL BY ANDERSEN SUBMIT A COPY OF STATE LICE 1920 COUNTY RD. "C" WEST YOUR STATE LICENSE ADDRESS:_ ROSEVILLE, MN 55113 CITY STATE ZIP WITH APPLICATION PHONE 651-264-4777 E' LICENSE #20130983 PROPERTY TYPE ❑ T'N PERMIT TYPE ❑ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIrRvDNG POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE EPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: 132aAC ! : 3 In l ryt o "-f / n/ 1-6,nc— - SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. 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 FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS Kes ❑No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF ®1 s t I !n (S/�fM lIlCAY1� . ISI �`Il�'►-� OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS 3 ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USINGTOTAL JOB VALUATION S ®19197 U.B.0 FEE SCHEDULE)OPTYPE Permit Fee $ 13 S. cs See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Surcharge $ 02 _ C\ (.0005) times the total job valuation — Minimum $.50 Fire Surcharge $ j -3 ? .001 x Permit Valuation (1/10%) License Surcharge $ S , pp $5.00 (State Licensed Residential Contractors) SAC Charge $ $1450 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $20 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ ?� �, j� Make checks payable to: City of Fridley Attach Stipulations 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 w hich requiresd approval of plans. SIGNATURE OF APPLICANT PRINT NAME-r�rh SC f4 DATE ��Z� 0 6 . .70/0 -O/ ql�� Building Permit Fee BUILDING Permit No.: Inspections $ RESIDENTIAL APPLICATION Received By: 763-572-3604CITY cv., / 7 Surcharge Date Rec'd/D �- s -O 9 License Surcharge OF FRIDLEY ' ; d U YOUR �SC3��dd �� on R E-MAIL ADDRESS 1-[_G% C • CCi�r� SITE ADDRESS I l03 V(0.o � C.. t � - THIS APPLICANT IS: ❑ OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: -S0\r'. Y\ TENANT ADDRESS: CITY STATE ZIP Total Due PHONE: 4 lQ 3-5+1-53%D f �- NAME: Renewal By Andersen CONTRACTOR SUBMIT A COPY OF STATE LICENSE ie_ 1920 County Road "C" West YOUR STATE LICENSE ADDRESS: Roseville, MN 55113 r STATE ZIP WITH APPLICATION PHONE License #20130983 ❑ SINGLE FAMILY/NEI 651-264-47.77 PROPERTY TYPE ❑ TWO FAMILY/NEW C _ PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: kC '-2) CAA) SIZE OF IMPROVEMENT LENGTH WIDTH GH Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT• GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan 2• Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structure ❑ Other ❑ 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 ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING TIM -1"7 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION S -5 1 11 J— Permit Fee $ 4,,,57- ®� Plan Review $ 4. Fire Surcharge cv., / 7 Surcharge $ -O 9 License Surcharge $ ' ; d SAC Charge $ Curb Curt Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ Total Due $ f �- 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 Davable 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 and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not permit but only an application r a permit qFq work is not to start without a permit; that the work will be in accordance with the approve plan in the case of all work w r uires r ew and approval of plans. {� SIGNATURE OF APPLICANT PRINT NAME/I �O►{a- Y`le h5d �� DATE �®