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PRE 2010 DOCSa, •CitY oFridley, F , Minn. BUILDING PERMIT No /- 7 - -o Date: - _...._......- --•-_.............---...._._.........._.-.._.._..._........_......._...._.. 440'7 Owner: ............- ............. _...................... _........................ _.................... Builder...... .......r�.�.........._ ....V-1...._.. ..... _... Address....._............._..-- _...._.._..._.__.....__..._.. _ _ .._................ Address ...------------......_....--------- L05ATION OF BUILDING No. ......... C�...._l ........ Street............. ._......�.._..._....................... /,....��,................... Part of Lot.....-------------------------------.................----------..._.._._ Lot .............-....... Block....._...........1...................... ----... Adctiiion or Sub -Division «�.. ii Corner Lot ...._X-----------------_... Inside Lot .................. . Setback .... 1 __.....fidey:ard ...Zd...-...........-_- SewerElevation ...... ..........................................------.....:....................................------ Foundation Elevation ................................... _............. DESCRIPTION OF BUILDING To be Used as: ✓� .. ... Front ._7... v;� �4 Hei 1...9.: S IAO rf r t -...� Depth ................... _. ght q. Ft. Q.. Cu. F� ! y / r 4 L .......... :...... Front ...� �� Depth c ._�. Heigh/t L...d. �.. Sq. Ft. .3-9.. -W.. Cu. Ft. Type of Construction.......................................................... Est. Corgi... Y.��Ci.. - .... 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 compliance with all of ordinances of the city of Fridley. 11117/ �/_provi 'ons In consideration of the payment of a fee of `...'- , permit is hereby granted _..._....... ........................................................ 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, 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. Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. p /K City of Fridley �s�Q Application for Plumbing and Gas Fitting Pemdt Y Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WOKSn C?_Z W2�i4 Number, Kind and Location of Fixtures i'BO PARTIAL RATE SCHEDULE 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 Building's, and hereby declares that all the facts and representations stated in this application -are true and correct. Fridley, Minn Owner a z � Kind of Building / Used as To be completed about PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 $ Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25, $ a + . WATER HTR. x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ -� Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ N GAS ELEC. m Base 1st 2nd _ 3rd _ 4th • Future Connection Openings Connected with I sewer New Fixture, Old Openings Cesspool ❑ PARTIAL RATE SCHEDULE 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 Building's, and hereby declares that all the facts and representations stated in this application -are true and correct. Fridley, Minn Owner a z � Kind of Building / Used as To be completed about PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 $ 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 $ °� O New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ -� Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description................................................$ TOTAL FEE $ / 9 Estimated Cost, $ OldCNew5L'ding Permit No a Permit No. 7 Signed ROUGH FINAL az 2fA 7-59 Business Phone APPLICATION FOR HEATING OR POWER PLANT AND SPECIAL DEVICE PERMIT PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ......................... 8.00 $ Replacement of Furnace ............................. 4.00 $ Repairs & Alterations—up to $500.00 ................. 4.00 $ _ Repairs & Alterations each add. $500.00 ............... 2.00 $-- MECH._ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ........... 8.00 $_� each add. 60,000 BTU ........................ 1.00 $ Replacement of Furnace ............................ 4.00 $ Repairs & Alterations—up to $500.00 ................. 4.00 $ Repairs & Alterations each add. $500.00 .............. 2.00 $ _ SIAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $-- _Furnace Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ 6Each add. 200 sq. ft. EDR Steam ...................... 2.00 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.00 $ _ OIL BURNER to 3 gal. per hour ........................ 4.00 $ over 3 gal. per hours—See Fee Schedule GAS BURNER .......................................... .roo $ G LJ GAS PIPING (Up to 5 Fixtures) .......................... AIR CONDITIONING FAN DATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ REMARKS: TOTAL FEE $ Dept. of Bldgs. Phone JU. 8-4614 Location The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the Village Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in thislapplication are true and correct. IiR 195- 95_ Owner Kind of BuildingeZ,2*a---PL-.p Used as , '��--' To be completed about — Estimate $ / Old—New. Building Permit No. _ DESCRIPTION DESCRIPTION OF 195- 195- 195-- 195__ HEATING or POWER PLANT am, Hot Water, Warm Air—No` /0 0Trade Nam s Size No.o_ Capacity V ,q.J . E.D.R BTU H. P. Total Connected Load, Kind of Fuel BURNER — Trade Name Size No ___ Capacity Sq. Ft. E.D.R BTU H. P. Si By 1001&-1 W-5-58 Business Phone No _ lniltraha9s � Via: aril kali Net cap. wan lot. wall Ceiling Floor Total Btm Reoired sq. h. FD.R. or sq. ins. */A. L.U&T egrets L,ieogt6 Witlth / 'mda Ora and Door--Craelsaae UJ Axem 17 �. r. M, Net exp. waH �iCeiling _< IRL wan -�, Flow , MA i ,yr ToW Btu. —I - IdI tragi Glass F.341. rwom Net vcp- IRL Won Ceiling Floor or sq. ins. W.A. uackr q n Len 4 WIckh —Craclu o and Am 1°J n. as I R. i1 rca ltsdte of Creek A9. M /& // 0 0 Total B”.---- ". Reauis� sQ. ft. E.D.I . or eco. im. W.A. _ a -7-(2000)-12-S7 ',lass N lElp, wall Pact exp. wall Int. wall Ceiling ToW Btm Required sq. ft. E.15K or act. ins. WA r Orta _ F1.1 1�eth "�Ilidth Illt `Xiindows and c te afta k► Idth bl sbt tea �M�b aeL A r fee. of Pane of fpanl� HOW AOSEy`Il..L HEAT LGA v Bin Imfileration � . _ ,,rt W�EAtI.&T:%tT�1A '� , � � '� � • .� � �,.r�'anCt-w�ti�,ll, • a, �d�8A�t7 Us �ut19�icC y 4 - 44 fl� Ape�lalslYe„ wa '�L a/ Roomxng aHrroCY im �' f .�. -. Room LengthFl.14 and ®CQTY�^ �acR3�0 t�IIf: eibca Windoees and P$CI�EA�SIG lA9A4'd R 1b4EF1 NM It1�Mi4 Width Helg a Idg. o A.Imonl ft. rTM^ II '^. b 1NIdcIw No. mf Pame Haight No. of aap L r� of Pane lixbts of eraeb a9• re Ne of gene of ®aae 1¢I¢A¢n oP arAele Cisef. lniltraha9s � Via: aril kali Net cap. wan lot. wall Ceiling Floor Total Btm Reoired sq. h. FD.R. or sq. ins. */A. L.U&T egrets L,ieogt6 Witlth / 'mda Ora and Door--Craelsaae UJ Axem 17 �. r. M, Net exp. waH �iCeiling _< IRL wan -�, Flow , MA i ,yr ToW Btu. —I - IdI tragi Glass F.341. rwom Net vcp- IRL Won Ceiling Floor or sq. ins. W.A. uackr q n Len 4 WIckh —Craclu o and Am 1°J n. as I R. i1 rca ltsdte of Creek A9. M /& // 0 0 Total B”.---- ". Reauis� sQ. ft. E.D.I . or eco. im. W.A. _ a -7-(2000)-12-S7 ',lass N lElp, wall Pact exp. wall Int. wall Ceiling ToW Btm Required sq. ft. E.15K or act. ins. WA r Orta _ F1.1 1�eth "�Ilidth Illt `Xiindows and c te afta k► Idth bl sbt tea �M�b aeL A r fee. of Pane of fpanl� HOW Bin Imfileration � Gibes 1 O o i . wan N�t exp- Wall lot. wall 00 - Ceiling Us Flor Total Btu. Ptequired sq. ft. E D R. or sq. ins. VA. Leaeler, ane 4 - 44 1lfl64aws and Doom—Crac Se and Area _ w deh NOSE16f Lineal ft. Are& M& oY Pane �f P&84e liffbqN, of ersek e!• 94 Bin lnflitxation / � Glaw ' _ Eap. wall Flit exp, wall IIsE; wall Leila"ng Floor o3 - -Total btu. egaYired fft. b-aA or sq. ins. W.A. L.eaaw aseret 45-)w? 53 -84 -s -9i5.51 MiNNEGASCO City of Fridley Appliaraba fid''a.raa end C--,qm Flarml Fenzala Dept. of Bldgs. Phone 360-3450 DESCRIPTION OF WOR>!Z 91 N. E. 66th. Way Number, Kind and Location of Fixtures .�1 N Xy11 UU e yN� y/ �•WATER yz O e N MTA. GAS FIEC. Base 1st Ins to 1 as Gri 11 2nd — 3rd 4th , • Future ConnecdLou Openings I c;onaeczea wun Sewer ❑ • New Fixture, Old Openings Ccsapool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................ x $2.00 $ Future Fixture Opening ............ x $1.50 $ _. New Fixture Old Opening .....:.... . x $1.50 $ Catch Basin .................... x $3.25 $ Water Heater (Up to 99,000 BTU).... x $3.00 $ New Ground Run Old Bldg. ........ x $3.25 $ Electric Water Hester .............. s $2.00 $ 3AS FITTING FEES: NO. RATE TOTAL ist 3 Fixtures . • ......... • . • • x $2.00 Additional Fixtures ................. x $ .75 Gas Range to 199,000 BTU.. . x $5.0D City of Fridley: The undersigned hereby makes application for a permit for the- work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct Fridley, Minn 7-24-7L. 19— Owner David L. Bender Kind of Building Frame Used as Res. To be completed about 7-31-74 Estimated Cost, $ 10.00 Old—MM!wxBuilding Permit No. Pe No. Signed By MIR EGASCO - - - Business Phone No ROUGH REPAIRS & ALTERATIONS—Refer to Cod& .50 State Surcharge Description .... Install, G$. G�•l� , • , , , , , .= 5.00 TOTAL FI±E Class r -A' Surcharge .50¢ SUBJECT City of Fridley r?12551 AT THE TOP OF THE TWINS BUILDING PERMIT r REC . • COMMUNITY DEVELOPMENT DIV. INSPECTION r PROTECTIVE SEC. � L1 = CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY ---•�/"','� j, 812-580-3450 910-F15 15/23/74 JOB ADDRESS 91 - 66th Way N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 4 SHEET Edgewater Gardens 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE D. Benden 91 - 66th Way N.E. 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. Milton Z. Johnson Co. 2513 Central Avenue N.E., Mpls, 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 CI ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS SEPERATE PERMITS REQUIRED FOR MIRING, HEATING, PLUMBING 'AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Alum. 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 R-1 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 y $13.00 SIGNATURE OF CONTRAOR AUTHORIZED AGENT (DATE) WHEN PROPERLY- VALIVATED THIS IS YOUR PERMIT /i' BLDG )NSP r)ATE SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) APPLICATION FOR RESIDENTIAL, AI;TERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME : ao D 9- n BUILDER : �-`� (S OJ ® /'yam S d G. ADDRES S : { I _ & 6 A /V, e . ADDRESS: S 3 �L= �► `�r�.w c_ . /!� NO:. / STREET: IJ- LOT: v-LOT: BLOCK: ADDITION: CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. To Be Used As: DESCRIPTION OF BUILDING. Front: Depth: Height: Square Feet: Cubic Feet: Front: Depth: .Height: Square Feet; Cubic Feet: Type of Construction: Estimated Cost: $ o� ®® v. c_ 7'/jjpL d - To Be Completed: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in st-kict 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: A'- 3Z - 7 SIGNATURE: (See Reverse Side For Additional Information.) Cil �� r,� Fi'iGICy ppliccaslon k. Plum !'o n o vil it - ' ._-_._.--•------ De�•t. of pld^•s. Pho-�o w�-3,:4 '•- ' DESC?IPTIO:t O:' WOOL: Lo.. 2i.^5.•r. »i=d a^.d L.•cr:ic+n o! - . uc"=ar Cc�.pcol PARTIAL RATE SCC�HI=DULE city of Fridley:. The undersignof hereby ::".-,lees ap-111catlon for a p,-rmit fer t2hr specified, a, -Cc,. -l- to do a-1 we -k in s: ct z'C=!cnce with the C:t�r and rt:.'.ing of the D•.-):jT r-.cn-t of and hereby declares L`.at a:I C e :aC • and re;.-esen:ations stated is t -his app:it:aiPm are true :.rA co^ec:• . • � 2 7�7 � 1 y� Owner Kind of B iIdi^.g L Used as t_'L92 To be completed about Estimated Cost, S c 0 ret oe it Iro ?.:nitc.p-.6�=•�----s- • I• FIaC': Ui':E PATES: N0. RATE TOTAL �- f$ { •^ ,WATt4 -Ti!- Fixtures ................ _ - W rAs tltC. By c �� • �>-� • Fxtu.a Opening ............ xSI.3 -• e, Bu-ine+s Phone :Io :. .ew Fixlu e Oli O+")ening.... • . x Si.50 d_:._. C21ch Basin .................... - x $3.25 $- Z,'atcr Iieater 'Up to 993.004 BTV) • • • ► x S300 5 — '• i I � I � 4 I .. . Meet -- Vlatar F&at.&r.............. s .`2•CJ $ — FI:v:�, Z�2� �si,S F:::i4G FEES- N O. Fin.. T TOAL ' - x - Ist 3 Fixtures .................. Ad�a:�nal Fixtures ............... _----- x S .75 5 Gas ?s..^. j t :o l U3.0G0 8 a u ........... ----------• uc"=ar Cc�.pcol PARTIAL RATE SCC�HI=DULE city of Fridley:. The undersignof hereby ::".-,lees ap-111catlon for a p,-rmit fer t2hr specified, a, -Cc,. -l- to do a-1 we -k in s: ct z'C=!cnce with the C:t�r and rt:.'.ing of the D•.-):jT r-.cn-t of and hereby declares L`.at a:I C e :aC • and re;.-esen:ations stated is t -his app:it:aiPm are true :.rA co^ec:• . • � 2 7�7 � 1 y� Owner Kind of B iIdi^.g L Used as t_'L92 To be completed about Estimated Cost, S c 0 ret oe it Iro ?.:nitc.p-.6�=•�----s- • FIaC': Ui':E PATES: N0. RATE TOTAL �- • Signed 5?5G4Fv:u-e Fixtures ................ _ By c �� • �>-� • Fxtu.a Opening ............ xSI.3 -• e, Bu-ine+s Phone :Io :. .ew Fixlu e Oli O+")ening.... • . x Si.50 d_:._. C21ch Basin .................... - x $3.25 $- Z,'atcr Iieater 'Up to 993.004 BTV) • • • ► x S300 5 — F20UGH Groj.^•d Run Old B!dg....:.... x :3.25 S .. . Meet -- Vlatar F&at.&r.............. s .`2•CJ $ — FI:v:�, Z�2� �si,S F:::i4G FEES- N O. Fin.. T TOAL ' - x - Ist 3 Fixtures .................. Ad�a:�nal Fixtures ............... _----- x S .75 5 Gas ?s..^. j t :o l U3.0G0 8 a u ........... ----------• - .50 State Suzch—ge PaX?A:PS & AL:EF.A?2.7Y•S--?e!er :o Coda �� ...................:........,..............� • TOT.A. ST:.x. S co"Iry 6431 UNIVERSITY AVE14UE N.E., FRIDLEY, MINNESOTA 56432 TELEPHONE ( 612)571-3460 m 9 OBSIRUCPION : Lot Block Addition hmperty 0imer -!.ddress RE -CORD OF COMMUNIC.NTIONS: 1. , 1171h7 2. 3. 4. S. G. 7. SUBJECT City of Fridley 24669 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC r CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 10/15/96 JOB ADDRESS 91 66 Way NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 13 I 4 I Edgewater Gardens SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dave/Wanda Hart 91 66 Way NE 571-6456 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Ken Bangsrud Construction 8805 Davern Ave NE Monticello MN 55312 7408 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 612-295-5937 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION p REPAIR ❑ MOVE ❑ REMOVE 11�� 8 DESCRIBE WORK Reroof House & Garage (24 S) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT 1 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 $1,980 $.99 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- Fire SC $1.98 STRUCTION OR THE PERFORMANCE OF ONSTRUCTION $62.25 `�� 41 PLAN CHECK FEE TOTAL FEE License SC $5.00 $70.22 SIGNATURE OF CONTROtTOR OR AUTHORIZED AGENT IDATEI WHEN PAOPE VALIDATED THIS ISYOUR PERMI B DG INSP DATE S,GNATURE OF OWNER IIF OWNER BUILDERI IDATEI IMA ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress: r - c c-/� ct t y Legal Description: � a 7 13 f '-�� y , '*//y, Lf6 Owner Name &Address: /-/). I e e A.,14 7/ -Tel. I/ #_ Contractor: % � y �Ya .' � MN LICENSE # Address: vvi Tel. # SS- s -S 3 7 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. Effective 3/1/96 -9=qq 7�' S7i- l�rr DESCRIPTION OF U"ROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: f'� d a 7�' Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x = $ DATE: �� s ! 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 $ $900 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 mark Fee $ Fee Determined by Engineering .ewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL s. G STIPULATIONS: suejECT T NO. City of Fridley 32991 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO r COMMUNITY DEVELOPMENT DIV. J/ / /LJ( r E PROTECTIVE INSPECTION SEC. I�(/(�� CF�J NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 763-571-3450 910.F15 8/16/02 JOB ADDRESS 91 66 Way NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DEscR. 13 4 1 Edgewater Gardens SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE David & Wanda Hart 91 66 Way NE 763-571-6456 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 O NEW ADDITION O ALTERATION O REPAIR 0 MOVE 0 REMOVE 8 DESCRIBE WORK Construct a 28' x 16' Deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. WARNING Before digging call for SEPARATE PERMITS all utility locations REQUIRED FOR:45"002 WIRING, HEATING REQUIRED BY Lei PLUMBING AND SIGNS SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT AUTHORIZED IS NOT COMMENCED WITHIN 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 ] 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 $5,152 $2.58 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- $125.25 Fire SC $5.15 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOT F E $132.98 SIGN AT ONTA ,CTO R ORA ORiZED T IOATE, HEN ROP VALIDA THIS IS YOUR PERMIT 'e"UMVEROY G• 8 -� S, AT317E O1 WN A,IF OWN iDATE, BLDt iNSp �i •TE NEW " ( ]— CITY OF FRIDLEY' Effective 1/1/2002 ADDN (j 6431 University Ave NE, Fridley, MN 55432 (763) 5723604 Bldg Insp ALTER (J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Addre Legal Description: W Owner Name & Address: 64 d- &4' 6U H"�-(i� Tel. # Contractor. S e t"P MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. �f GARAGE AREA: Length Width Height Sq. Ft. �< DECK AREA: Length -- -- Width �, Hgt/Ground Sq. Ft. OTHER: Construction Type: R,7 -F5 -5("W- 0 Estimated Cost: $ Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $ DATE: /&oZAPPLICANT:4j6L,094- Tel. # "76 3 7 Call (763) 572-3604 for Permit Fees If mailing In application or Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1200 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 [ J STIPULATIONS: Gl t sm ■■®i ■ii® ■■■i ■■i■■ii®iiiiiiii■■■■■ ■■■■■■■■■■ IRE ■■■M ■■■ ■IRE■■■■■■■■■■■■iii ■i■ EMMENNIM31= ol A www =RON HARVEY A. CARTWRIGHT ANOKA COUNTY SURVEYS HENNEPIN COUNTY SURVEYS MINNEAPOLIS SURVEYS 8410 PALM STREET N W. SUN9FT 4.7655 OWNER INDUSTRIAL - JUDICIAL BUSINESS - TOPOGRAPHICAL CITY LOTS - PLATTING Andrew Hohn CMTWMGHT & OLSON LAND SURVEYORS REGISTERED UNDER LAWS OF STATE OF MINNESOTA LICENSED BY ORDINANCE OF CITY OF MINNEAPOLIS 326 PLYMOUTH BUILDING FEDERAL 8-8721 HENNEPIN AT SIXTH • MINNEAPOLIS 3. MINNESOTA 6tirbepor'g Cmittratc COMBINING THE RECORDS OF J. E. HILL, CIVIL ENGINEER ESTABLISHED 1896 C. F. SANDHOFF CIVIL ENGINEER ESTABLISHED 1900 JAMES NELSON SURVEYOR ESTABLISHED 1911 METROPOLITAN LAND SURVEYORS. LSrAGLISHEO 19-31 Invoi::e d21010 60�(1/30 �- SCALE : I' =30' DENOTES STAKES i ent y e'O (s �r1 I ' I I/OCO �IA i Q ok VIPAy �N(p 0� T 0� CJ w I hereby certify that this is a true and correct re resentrtion of a survey of: Lot 13, Block 4, Edgewriter Gar,:eus, Anoka County, i:irnesota. As surveyed by me this iii r.^y o.f „c; b: •,19594 of SIGNED: N GA--rRIGHT AND OLSON —� DATE: August 16, 2002 TO: File FROM: Scott J. Hickok, Community Development SUBJECT: Deck at 91- 66th Directo ) After careful review of the Zoning Code in effect, at the time of this original building permit, I have made the following determination: 1) The home was built in 1960. The 1955 (amended 1958) Code, in effect at the time, requires 2 setbacks of 10' in the R-1, Single -Family Residential district. Two exceptions exist. On corner lots (if the house to the rear faces the side street) the setback must be no less than 1/2 of the front yard setback of the house to the rear. In other words, the house to the rear (if it has a 35' front setback) would require that no less than 17 % feet be allowed on this side yard. Absent that condition, Code would allow 10' on the side corner. The house to the rear of 91 66th Way does not face Hickory. Therefore, the side yard on Hickory at 91- 66th can be 10', in accordance with Code in 1958. 2) Today's Code language is specific on garage -side, dwelling -side setbacks. In the 1958 Code the simply states the following: "The side yard on the side of a private garage attached to a dwelling at one side, may be reduced to not less than 5 feet, provided the height of the building on that side is not more than 15 feet". There is no discussion about living area connected; simply the garage side may be reduced to not less than 5 feet. Therefore, the setbacks on this property are conforming for the date the home was constructed. A permit may issue. regulations of the district in which said structure is located. Any sucH structure shall be subject to any and all applicable regulations herein for non -conforming uses except in the event the city council shall require removal of the struc- ture or portion thereof for a public purpose, in which case such re- quirement shall prevail. The council may acquire by pur- chase, condemnation or otherwise, private property for the removal of non -conforming uses and struc- tures and may in its discretion provide that the cost and expense of acquiring such private property be paid from general funds, or the cost and expense of any portion thereof be assessed to a special district. Section 7—AUTOMOBILE PARX- ING SPACE REQUIRED Whenever any plan or require- ment or providing or reserving off-street automobile p a r k i n g spaces in one or more sections of the City of Fridley shall be adopt- ed by the city council, then such plan or requirement shall govern within such sections. Otherwise off-street automobile parking spaces shall be provided as fol- lows, applicable to buildings here- after erected, constructed or moved and to uses hereafter estab- lished, to such non -conforming uses as may be required to con- form to the regulations hereof, and to extensions and enlarge- ments of buildings and uses. 1. Off-street parking spaces shall be provided at the ratio of 1 parking stall for: (a) Each dwelling unit in any dwelling, or other building. (b) Each sleeping accommoda- tion in any automobile court or tourist home and each camp unit in any automobile camp. (c) Each 3 sleeping accommoda- tions in any hotel, boarding house, fraternity or sorority house, or dormitory, in addition to the number of parking stalls required for its dining and enter- tainment uses. (d) Each 3 beds in any hospital. (e) Each 6 beds in any sanitar- ium, convalescent home or similar commodations in any restaurant, theatre, auditorium, stadium, church, entertainment use, hall for meetings, dancing or social events, and other use where seats or similar accommodations are provided for gatherings of 6 or more persons. (g) Each 500 square feet of ground floor area in business or commercial use, each 1,000 square feet of basement floor area in such use, each 1,500 square feet of floor area in such use above the first floor, provided that for such establishments as drive-in markets and similar and other businesses catering to drive-in patronage, the required ratio shall be 3 parking stalls for each 190 square feet of total area in business or commercial use with- in buildings and outside, includ- ing ground area in such use. (h) Each 3 persons (including proprietors) of maximum em- ployment in a single shift in any light or heavy industrial use. 2. In any C -1S or C -2S District, parking spaces required for all permitted buildings and uses shall be not less than 3 parking stalls for each 190 square feet of total area in business or commercial use within buildings and outside. 3. Each business, commercial, manufacturing or industrial use having deliveries made by truck more than once a day between the hours of 8 o'clock A.M. and 6 o'clock P.M., or where the time of loading and unloading materials or goods exceeds 10 minutes be- tween those hours, shall provide off-street truck loading space on the lot, such space to be not less than 35 feet in length, 12 feet in width and 15 feet in height. 4. For the purpose of this ordi- nance one parking stall shall bd not less than 190 square feet in area, in addition to whatever area is required for satisfactory move- ment into and out of such stall except that in the case where at- tendants perform the act of park- ing in defined and adequate stalls then each such stall shall be con- sidered a parking stall as re- w4rn.l hnrnin single parking space or to a park- ing lot shall be not less than 12 feet, nor more than 25 feet in width at the property line along the street and shall be so located as to minimize traffic hazard and congestion, provided that this width shall be 10 feet and no wider for a driveway serving res, idential parking spaces. 6. All required parking stalls shall be located on the premises to which such requirement applies or on an off-street space distant not more than 500 feet from such premises, provided that stalls re- quired for employees and propri- etors of any premises may be located on an off-street space dis- tant not more than 1,000 feet /� from such premises. \. Spaces for open parking stalls \7 .dhd truck loading shall not occu- py any portion of a required front yard or side yard and shall not occupy more than 1/s of the area of a required rear yard. 8. Provision of parking stalls jointly by several uses in the same block or in the same vicin- ity is permissible, in which case the number of stalls required shall be the sum total of the indi- vidual requirements, provided that where it is found by the board of appeals, upon applica- tion thereto, that the parking demand generated by the differ- ent uses included in any joint arrangement to provide parking stalls required herein occurs at distinctly different times, as in the case of a store generating de- mand for parking during its day- time business hours and a theatre generating p e a k demand for Parking after such daytime hours, and in similar cases, the board may recommend to the city coun- cil and the council may reduce the total number of parking stalls to be jointly provided. 9. Al) required parking spaces pro- vided on a lot or in a building shall be unobstructed and usable for the purpose and shall not be reduced. 10. The surfaces of parking stalls and aisles, truck standing spaces and access driveways therefor 11,,11 1... 4nn 0-I .,.... ,.I ...,, age and freedom from dust, dirt and mud. Section 8.—YARDS, LOT SIZES, OPEN SPACES REQUIRED Yards, lot sizes and open spaces shall be as required in this section for buildings hereafter erected in R-1. R-2, R-3, C-1, C-2, M-1 and M-2 Districts, except as otherwise provided herein. Minimum open spaces and facilities shall be as re- quired in Section 8.8 for building developments in C -1S and C -2S Districts. No lot shall be so reduced or diminished, nor shall any struc- ture be so enlarged or moved, as to reduce or diminish the yards, lot area or open space required herein in the district in which located. No yard or other open space re- quired herein for any building shall be considered as providing a yard or open space for any other building, and no yard or open space on an adjoining lot or parcel of property shall be considered as providing a yard or open space on a lot whereon a building is to be erected. Section 8.1—SIDE YARDS RE- QUIRED A. R-1 and R-2 DISTRICTS: Two side yards are required, each with a width of not less than 10 feet. B: R-3 DISTRICTS: Same as in R-1 Districts, provided that 1 ad- ditional foot of width of each side Yard is required for each 4 feet, or portion thereof, of building height in excess of 35 feet. C. C -I, C-2, M-1 and M-2 DIST- RICTS: Two side yards are re- quired for a building containing any dwelling units. One side yard is required on the side of any other lot which side adjoins any R-1, R-2, R-3 or C -1S District. None are required otherwise. The width of each side yard shall be not less than 12 percent of the lot width, with not less than 6 feet permitted or more than 12 feet required. D. SIDE YARD EXCEPTIONS: The side yard width on a street side of a corner lot shall be not less than % the distance of the I . . . said lot to the rear thereof has frontage along a side street, and In such case no accessory build- ing on said corner lot shall be closer to said side street than the distance of the front yard depth requirement for the lot to the rear thereof; provided, however, that this regulation shall not be so interpreted as to reduce the buildable width of a corner lot to less than 25 feet, nor to prohibit the erection of an accesory building where compliance with this regulation cannot reasonably be had. The side yard on the side of a private garage attached to a dwelling at one side, may be re- duced to not less than 5 feet, provided the height of the build- ing on that side is not more than 15 feet. Section 8.2—REAR YARDS RE- QUIRED A. R-1 and 11-2 DISTRICTS: A rear yard with a depth of not less than 25 percent of the lot depth is required, with not less than 25 feet permitted or more than 40 feet required for a dwelling, and not less than 30 feet permitted or more than 75 feet required for any other kind of main building. B. R-3 DISTRICTS: Same as in R-1 and R-2 Districts, provided that 1 additional foot of depth of rear yard is required for each 2 feet or portion thereof, of build- ing height in excess of 35 feet. C. C-1 DISTRICTS: A rear yard is required only for a building containing any. dwelling units and on any lot, the.iear or side line of which adjoins any R-1, R-2, R-3 or C -IS District, and the depth shall be not less than 25 feet. D. C-2, M-1, M-2 DISTRICTS: Same as in C-1 Districts, provided that 1 additional foot of depth of rear yard is required for each 4 feet or portion thereof of building height in excess of 35 feet. E. REAR YARD DEPTH, WITH ALLEY ADJOINING: In com- puting the depth of a rear yard for any building where the rear line of the lot adjoins an alley, % of the width of such allpv may actually on the lot shall be not less than 20 feet in any dwelling district and not less than 10 feet in any other district. Section 8.3—FRONT YARDS RE- QUIRED A. R-1, R-2, R-3 and C-1 DIST- RICTS: A front yard with a depth of not less than 35 feet is required. e�IBoC-2, M-1, M-2 DISTRICTS: ne, unless a block is partly in a C-2, M-1 or M-2 District and partly in another district, in which case the front yard depth required in such other district shall apply a l o n g its entire length. C. FRONT YARD EXCEPTION: In a block where the average of the front yard depths of existing buildings within a distance of 100 feet on both sides of a building to be erected is not more than 6 feet greater or not more than 6 feet less than the front yard depth required for the district in which such block is located, the front yard depth for such buildingshall' be not less than such average depth. Should this difference be more than 6 feet the board of appeals may vary the front yard requirement for the building. Section 8.4—LOT AREAS RE- QUIRED A. R,-1 DISTRICTS: A lot area of not less than 9,000 square feet for a dwelling is required, or not less than 7,500 square feet, if the' lot is one on a subdivision plat recorded prior to the effective date of this ordinance or on a plat approved by the City council subsequently, provided that an area of not less than 18,000 square feet is required for a lot unserved by a City sani- tary sewer or an approved pri- vate, community sewage disposal system, or not less than 10,000 square feet if the lot is one on a subdivision plat recorded prior to the effective date of this ordi- nance or on a plat approved by the City council subsequently. R. R-2 DISTRICTS: A lot area of A lot area of not less than 10,000 square feet for a two, three or four -family dwelling or dwelling group is required. A lot area of not less than 1,500 additional square feet for each dwelling unit over four in num- ber, is required. C. R-3 DISTRICTS: Same as in R-2 Districts for each dwelling or dwelling group having four - dwelling units or less. A lot area of not less than 1,000 additional square feet for each dwelling unit over four in num- ber, is required. D. C-1, C -1S, C-2, C -2S, M-1 AND M-2 DISTRICTS: Same as in R-3 • Districts for any building containing any dwelling units. No requirement for any other build- ing. E. LOT AREA EXCEPTIONS: A one -family dwelling may be erect- ed on any lot or parcel of land in any R-1, R-2 or R-3 District, re- gardless of its area or width, if the owner of such lot or parcel of land, on the date of establishment of the District in which located, did not own, and the owner at the time of application for a building permit does not own, any adjoin- ing land. In computing required lot area, the width, but not exceeding' 10 feet, of any alley or portion thereof abutting any lot line may be included as part of the lot area for such computation. Section 8.5—LOT WIDTHS RE- QUIRED A. R-1, R-2 and R-3 DISTRICTS: A lot width of not less than 75 feet for a one -family dwelling, is required, or not less than 60 feet if the lot is one on a subdivision plat recorded prior to the effec- tive date of this ordinance, or .on an officially approved plat re- corded subsequently. A lot width of not less than 75 feet is required for dwellings and multiple dwell- ings having from two to four dwelling units. A lot width of not less than 85 feet is required for multiple dwellings having more than four dwelling units. T) r-1. r -1S. C-2. C` -2S. M-1 and dwellings of various kinds and/foi any building containing a n y dwelling units. No requirement for any other building. Section 8.6—LOT COVERAGE BY BUILDINGS A. R-1, AND R-2 DISTRICTS: Not more than 25 percent of the area of a lot shall be covered by the main building and all acces- sory buildings. B. R-3 DISTRICTS: Not more than 30 percent of the area of a lot shall be covered by the main building and all accessory build- ings. C. C-1, C -IS, C-2, C -2S, M-1 AND M-2 DISTRICTS: For any dwell- ing and for any building contain- ing dwelling units, the area of the lowest floor containing any such unit and each floor above it, to- gether with the area of all acces- sory buildings, shall each be not more than 40 percent of the area of the lot. No requirement for any other building. Section 8.7—MINIMUM FLOOR AREA REQUIRED Any dwelling in any District, ex- cept any in a dwelling group, as defined herein, shall have a first - floor, area of not less than 756 feet, exclusive of accessory build- ings or an,attached garage. Section 8.8—ADDITIONAL REG= ULATIONS — YARDS, LOT SIZES, OPEN SPACES A. YARDS, COURTS AND LOT COVERAGE FOR DWELLING GROUPS: 1. For dwelling groups, the side of a building shall be not closer to the side of any other building (arranged "side by side") than 15 feet, the rear of a building shall be not closer to the front or, side of any other building ("rear to front" or "rear to side'; re- spectively), or the side of a build - Ing -shall be not closer to the front of any other building ("side to front") than 30 feet, provided that the highest building rearing between any two buildings shall be increased by 4 feet for each: story that the higher building ex- ceeds 1 story in height. HARVEY A. CARTWRIGHT CMMNWWff & OLSON ANOKA COUNTY SURVEYS p HENNEPIN COUNTY SURVEYS LAND S U.l VE YORS MINNEAPOLIS SURVEYS 8410 PALM STREET N W REGISTERED UNDER LAWS OF STATE OF MINNESOTA SUNe F, 4-7655 LICENSED BY ORDINANCE OF CITY OF MINNEAPOLIS OwvE4 326 PLYMOUTH BUILDING FEDERAL 8-8721 INDUSTRIAL — JUDICIAL HENNEPIN AT SIXTH- • MINNEAPOLIS 3. MINNESOTA BL,SINESS — TOPOGRAPHICAL *urtatpor'o Catiftcatc CITY LOTS — PLATTING C Andrew r',Jq �\ t 1 i O tv_ i }i A COMBINING THE RECORDS OF J. E. HILL, CIVIL ENGINEER ESTABLISHED 1890 C. F. SANDHOFF CIVIL ENGINEER ESTABLISHED I9W JAMES NELSON SURVEYOR ESTABLISHED 1922 METROPOLITAN LAND SURVEYORS, LSTABLISHED Ines IrvGice ,x-1'..1:1 699/30 SCALE:: I u= 3.0" d—DENC7ES STAKE'S j- _ �� r`l� s'o ';I,.9 1,q. (� CP, a\ �a } \�Nl X6 03 , _.•Iia,66 Iii''. I hereby certify that this is a true and ccrrsct representation of a survey of: Lot 13, dock 4, Edgewater Gar,'.er:s, Ancka Ccunt�', i:ir_nescta, As S�:I"IFV£a r'�I i'G + ;1:. ---v�: -.rr''�^ _... _ .. 1•:a��a ,GA� 'RIGHT ANo OL90N ; Li CITY ITY OF FRIDLEY BUILDING INSPECTION O Zffe G - D � ctive 4/1/2004 9 3431 University Ave NE 9 Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION L 763-5723604 FAX 763-571-1287 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES D "l I tv G'_ JOB ADDRESS n RATE SCHEDULE Fee, Total \ \ Residential Owner Furnace Shell and Duct Work, Burner & �'e also Replacement Furnace $35.00 $3S. Building Used As` S e nc Ie Gas Piping (Ne%v Furnace, Fireplace, Insert) $10.00 $ ESTIMATED COST CP 00 •O PERMIT NO Gas Range $10.00 $ DESCRIPTION OF FURNACE AND BURNER Gas Dryer $10.00 $ # of Heating units__ Circle One (Steam) (Hot Wate Warm Air) Trade Name C e r 'S6 Size No. *Air Conditioning -All Sizes $25.00 $ ��,00 BTU l HP EDR Q..rr'k\e,r 3� TY 03`4 Fuel t uCcA-S Total Connected Load All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or WorX $ Burner Trade Name Size No. Minimum Fee $15.00 for Residential or 5% of cost of BTU HP EOR a Improvement whfchever is greater on work less than $300.00 The undersigned hereby makes application for a permit for the work herein 5 Commercial/industrial/Institutional specified agreeing to do all work in strict accordance with the City Codes r 1.25% of Value of Appliance or Work (List on Back) $ and rulings of the Building Division, and hereby declares that all the facts Minimum Fee $35.00 for Commercial/industriaVinslitutional and representations stated in this application are true and correct. CENTERPOINT ENERGY r State Surcharge .50 HEATING CO 13562 CENTRAL AVE NE BLAINE, MN 55304 1 TOTAL FEE $ Lob.' � �_ -757-6202 Signed Tel # 763 % REINSPECTION FEE $50.00/HOUR FAX # 763-757-6701 Date *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City o- N af FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Cr Approved by Rough -in Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When reellacing 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 No ( ) specifications including sizing, length, number of elbows and termination. Yes (� 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 air is sized and installed to meet the current codes -combustion and manufacturer's specifications. Yes (i1 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 -LAMA 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 t) No ( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type r I BTU Input 9 0_ oo o Fan Assisted or Nat i Appliance #2 Type eJ � . 1�BTU Input . �a Fan Assisted or Nat A� Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input r �• Common Vent Type e/- r�i Vent Height f Diameter inches Appliance #1 Vent Connector Height ft Length, L_ft Diameter n TypeC! Appliance #2 Vent Connector Height -_(—ft Length _,LLft Diameter s` ,in Type 0 �– Appliance #3 Vent Connector Height ft Length ft Diameter / in Type ALTERATIONS: (Describe) lo? I/ sem' CENTERPOINT ENERGY HEATING CO: 13562 CENTRAL AVE NE BLAINE, MN 55304 Signed By: Date ear ?A/FA • rl TPV.gJSL Ol A31G 1 NA d0 AI J O WONA (7: T T b002-LZ-Nd8