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PRE 2010 DOCS• • • • • /�? 7,3e' City of Fridley, Minn. BUILDING PERMIT N° 6 416 owaer: Builder AddressAddress LO TION"MILDING � -_ No. Street Part Of Lot _ ___ Block dation or Sub -Division � i 0 Corner Lot . _ Inside Lot d� Setback Side and — s� Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To Used / /�� Front Depth44. Height Sq. Ft. cu. Fro t Deptheight 1.2 Sq. Ft. �Tz Cu. eo Type of ction Fst�� Completed Ft. Al®4 � 7 Ft. W -69 -t - In consideration of the issuance to me of a permit to construct building described above, I agree to do the proposed work in accordance with the description above set fo and in complian with provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $� , permit is hereby granted to 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 viten of aay of the provisions of said ordinances Building Inspector NOTICE: 'lids permit dose not corer the constroction, hmftl ion for vtb%& plumbine, gss hosing, sower or water. Be sure to ase the Building Inspector for sopmft permits for these i cam Owner' Addres APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA LOCATION OF BUILDING No. Street Part of Lot Lot �~ Block Addition or Subdivisiona4ezrm�— Corner Lot Inside Lot Setback. K_3�­Side-Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: Frontjj }' !l _Depth Height Sq. Ft .z li' 6j Cu. Ft. FrontDepth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost To be Completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and ruling of the Department of Build- ings, and hereby declares that all the facts and representations stated in this application are true and correc . ZZDATE 2- , SIGNAT (Schedule of Fee Costs can be found on the Reverse Side). r AppReation for Power Pkmts and Heaft, Coding, Ventilation, .Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL, Furnace Shell & Duct Work .................. I ....... 8.00 $ Replacement of Furnace 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $— each add. 60,000 BTU ....................... 2.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 ....... :...... 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam .:..... 8.00 $ Furnace Shell & Line—to 640 sq. ft. IDR Hot Water ... 8.00 $ Each add. 200 sq. ft. IDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................:. ... 5.00 $kle-, GAS FITTING FEES: -NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ ✓ N Additional Fixtures x .50 $ r Gas Range to 200,000 BTU ........... x 2.00 $ k-la'&R CONDITIONING `FAN DATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS r ROUGH FINAL Dept. of Bldgs. Phone SII 4-7470 1-199 141 City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn 7 —�� 19 _ Owner � � 7eW2E . Kind of Building Used as To be completed about � 3® "G Estimated Cost, $ �d Building Permit No. permit No. =2_, �— DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Hot/Water, Air o Trade Nam .�rl.�u•— <� J�tr� Size No- 22/i5` ®®J— Capacity Sq. Ft. E.D.R. SUS^� BTU H.P. Total Connected Load .:f— 720 0 Bind of Fuel �L BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS—OVER) S* gner IIARNIG PLUMBING & NEATIW ANOKAA, MINN. —TEL. HA. 1-1392 By 42 2M 7-5e Business Phone No At HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDING Weatherstrips A.S.H.V.E. Guide Reference 19— Glass Construction No. Exp. wall Insulation Windows Yes—No I Doors Yes—No Out. Wall Int. Wall Ceiling Roof Floor Kind How A Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 F 8,,k F1.1 oom I Length /P Width // Height Fl.l /% Room Length Width Windows and Doors—Crackage and Area Windows AnelDoors—Crackage and Area Width Height No. of Lineal f . Area No. or pane o lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. -pane / Pip If. "Y, 3 :3 9 a D Coef.1 Btu C Infiltration, Infiltration Glass Glass c3 J Exp. wall - s a i Exp. wall Net exp. wall 3 a/ /d a / 3 b Net exp. wall /77 Int. wall Int. wall Ceiling 37 Ceiling /43 Floor / Floor /6J Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Room I Length & Width //e Height Room I Length .5-- Width Windows and Doors--Crackage and Area lCoef.1Btu Windows and Doom-Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. tt. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. -'0- ° 1 P a Infiltration 120.7 Glass 410 Exp. wall Net exp. wall Net exp. wall Int. wall Int. wall Ceiling Ceiling Floor Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 F 8,,k I Room I Length // Width /, Windows and oors—Crackage and Area Width No. of Dane He ght No. oL Linea! ft. Aja of ane Ilghts of crack sq it sJ/ 1 � C Infiltration Glass Exp. wall x (� Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area B.D. 218 Btu 'L v tzv Glass I Pat. 10 1 // 3 J Exp. wall .9 yxO'-- Net exp. wall Int. wall v l L Ceiling V % G Floor Total Btu. Mi quired sq. ft. E.D.R. or sq. ins. W.A. Leader area 1.1 Room I Length —7 Width Windows and Doors—Crackage and Area Width Height No. of Licracneal tt. Area Of pane -!.pane lights of k eQ. Lt. 'al -3 /av 2 3u Btu -50 —3 V Infiltration I a D Glass Exp. wall Net exp. wall Int. wall Ceiling (fes Floor --2 z, 11 Total Btu. -- Height y' f oil 'l ij -r7 / J� 'oef. Btu W /"V 5'V -'O 0 /D I/D Required sq. ft. E.D.R. or sq. ins. WA. Leader area t HEAT LOSS CALCULATIONS DEPARTNENT OF BUILDINGS Y Weatherstrips A.S.H.V.E. Construction No. Insulation Guide Windows Doors Reference Out. Wall Int. Wall Ceding Roof Floor Kind How Applie Yes—No I Yes—No 1 19_ Fl Room 1 Length `JWidth % Height -P F1.1 Room I Length Width Height Windows and Doors—Crackage and Area I Width Height of Lineal ft. Area No. of pane of Dane lig lights o[ crack eq. ft. —4- Tag Coef. Btu Coef. Btu Infiltration Exp. wall c3 7y Glass 193/ Int. wall Exp. wall = S% G Floor _ Net exp. wall Int. wall Ceiling ��a... Floor 4-7L -V- V / ' Z Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Room I Length Width Windows and Doors—Crackage and Area Width Helght No. of Lineal ft. Area No. of pane of pane lights of crack aq. ft. Infiltration Glass Exp. wall Net exp. wai Int. wall Ceiling Floor Total Btu. Coef.l Btu I Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.1 Room I Length Width Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Infiltration Glass �' Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area B.D. 218 Btu Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack eq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI -1 Ream I Length Width Height Windows and Doors---Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI -1 Ranm I "north Width 14Aaht Windows and Doors—Crackage and Area width Height No. of Lineal ft. Area No. of pane of.pane lights of crack aq. tt. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. WA. Leader area City of Fridley Application for Plumbing and Gas Fitting Penidt DepL of Bldgs. Phone SII 4-7470 00, DESCRIPTION OF WORK v � 6/ Number, Kind and Location of Fixtures Loc fl-- % G7 C N Y1{ Zf1 flu Z -jC9 (1 Z t WATER HTR. �� in� o� aaj U jp <3 �O F N GAS ELEC. W 3(� Base 1st 2nd _ 3rd — 4th • Future Connection Openings Connected with Sewer � New Fixture, Old Openings Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 $ 66 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) ......--Z x 2.00 $ of, — New Ground Run Old Bldg. x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL _V 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 City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do a11 work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. .n . I /I Kind of Building �� / /J %i_ A . Used as J To be completed about Estimated Cost, $ Old—New. Building Permit ROUGH FINAL 19" az 2M 7-59 SUBJECT P NO. City of Fridley 14850 AT THE TOP OF THE TWINS BUILDING PERMIT �ECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. R� r' 1 � i �l II CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY ,'j 612-580-3450 910-F15 8/11/78 JOB ADDRESS 40 - 66'31 Way N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 4 1 Edgewater Gardens SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Richard Blair 40 - 66h Way N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Patio Village 3918 W. 49h Stmt 26-2771 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential - 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE B 8 DESCRIBE WORK r r and a 101 r Deck 9 CHANGE OF USE FROM TO STIPULATIONS Call for footing inspection. SEPERATE PERMITS REQUIRLD FOR WIRIK, HEATING, PLUMBING AND SIGNS. WARING 841we digging call 1oc'11 uci 1ELE?HONE - . e REQUIREcJ TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION I ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED. WITH HEREIN OR NOT. THE GRANTING $6,500 $3.25 WHETHER SPECIFIED OF A PERMIT DOES NOT P UME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIO O ANY OTHER STATE OR LOCAL LAW REGULATING CON. ST UCTI THE PERFORMANCE OF CONSTRUCTION. $39.00 PLAN CHECK FEE TOTALFEE 4( 76 $42.25 SI NAT E 8FCO TRAC OR AUTHORIZED AGENT (DATE) WHEN PROPERLY YALIDATED THIS IS YOUR PERMIT BLDG INSP DATE SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) I CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS G (NEW, ALTERA-Fluijs, ADDITIONS, OR REPAIRS) OWNER: 1 G A\ LD BUILDER: O I L, l- X F— Address : -�{p �� �`i ���( Address: �� 1�. 49 5-'-- Tel. NO No.: Street: LOT: BLOCK: ADDITION: CORNER LOT: INSIDE LOT: SET33ACK: SIDEYARbS: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: t ..7, t2�t} ENcL... Front: Depth: % Height: oft EON Mem. W Square Feet: 12'® Cubic Feet: Lick- Front: 'J Depth: / <>• Height: -2-4 a Square Feet: Cubic Feet: 00 Type of Construction: ME..� Estimated Cost: $ 9b Be Completed: ��'� Alt. A Alt. B Pr6posed 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 i cldital information. DATE: t�j AV 7, SIGNATURE: c Stipulations: t p�llLy�- 3 f • oe e�UJ 3. L �• Q da� 35% o-.. Lncf�uc 3 .Z -S-- City of Fridley AT THE TOP OF THE TWINS SUBJECT BUILDING PERMIT PIERO, 18978 r 1 • COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. i •.-. A "1,� CITY HALL FRIDLEY 55432 612-571-3450 REC NUMBER 910-F15 REV. DATE 6/2/87 PAGE OF APPROVED BY JOB ADDRESS 40 -. 6611 Way N.E. 1 LEGAL DESCR. LOT NO. 5 BLOCK 4 TRACTOR ADDITION Edgewater Gardens SEE ATTACHED SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Richard/Bette Blair 40 - 66h Way N, E. 574--7431 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 10' x 12' Shed in Back Yard 9 CHANGE OF USE FROM TO STIPULATIONS Shed to be in line with Garage, 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 AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION ZONING SQ. FT. CU. FT. 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 AND,ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT VALUATION $1,000 SURTAX $.50 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. $17.50 PLAN CHECK FEE TOTAL FEE $18.00 SIG n UR CONTR DTE v WHEN PROPERLY V DATED THIS IS YOUR PERMITQQlam ARIZEYDA,E SIGNATURE OF OW NERIIF OWNER BUILDERI IDAT I BLDG INSP AT NEW [OJ City of Fridley Effective 4/1/86 ADDN. [ ] R-1 AND R-2 ALTER. I ] Building Permit Application � `1� Construction Address: �ss� �ce wc� �cu� Gvs LQ% S, i"S�oc•� Legal Description: i 57�_ %�3 Owner Name &Address: ` ► C6 A V S pJe I� I I�} pT Tel. # Contractor: S'-ILrs B_r d'Ae_ `S�60?P"rt�' - Tel. # - Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height , Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. _ OTHER: S v- A e. exI C3 X` 2 C Y Sid Ft. Yd. Setback e Yard Setback Corner Lot [ J Inside Lot [� - � Type of Construction: VVO ci Estimated Cost: $ ©®® Approx. Completion Date: �° I �S I i N 14, Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: - $ - $ &�� See Back Page for Explanation DATE. S7y7�1�/-I Tel. # . I � � APPLICANT: � �`-' Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY $ / , �� Fee Schedule on Reverse Side $ 25% of Building Permit Fee $ �7) $.50/$1,000 Valuation $ $ 525 per SAC Unit $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] 0 SUBJECT PE . _ City of Fridley2 7 59 5 AT THE TOP OF THE TWINS BUILDING P E R M I T""� / ` ECEIRT-NO. i _ COMMUNITY DEVELOPMENT DIV. v PROTECTIVE INSPECTION SEC. r OY NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910_F15 9/8/98 JOB ADDRESS 40 664 I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 4 lEdgewater Gardens SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Richard Blair 40 661 Way 55432 574-7431 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO B & B Roofing -0248 9042 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 O ADDITION ❑ ALTERATION :7 REPAIR O MOVE ❑ REMOVE 9 DESCRIBE WORK Reroof house & garage, (26 SQ), Tear-off 9 CHANGE OF USE FROM TO STIPULATION S Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL. PLUMBING. HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION I 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 $2228 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOE T PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISI NS OF ANY OTH R STATE OR LOCAL LAW REGULATING CON- PERMIT FEE -_ $74.75 SAC CHARGE Fir SC $2.23 S RUCT ON OR THE PER RMANCE C STRUCTION. PLAN CHECK FEE TOT L FEE License C $5. $83.09 SIGNATOR OF TRACTOR RAUTMORI2ED AGENT IDATEI N ROP VALIDA BL INSP THIS I$ Y R PERMIT v s VrTE SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI ZMA ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: �� 61" , Legal Description: Effective 1/1/98 Owner Name & /Address: �i�1('// , l �� /��- Tel. #-,5 7�-7q-51 Contractor: �/ � 14-- / /Y MN LICENSE # �G `S Z, Address: Tel. # ems `l� Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Typec�(a Estimated Cost: $ ��� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: Zk� ` APPLICANT: 1 02 �� / /��L Tel. # S �� Yd Permit Fee Fire Surcharge State Surcharge $ SAC Charge $ License Surcharge $ Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $ 65 ' 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 [ ] CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 FAX: (763) 571-1287 ADDRESS : 40 66 1/2 WAY NE PIN : 153024140018 LEGAL DESC : EDGEWATER GARDENS WATER TREATMENT APPLIANCE : LOT 5 BLOCK 4 PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT �.-_20000,��O-,,pO DATE ISSUED: 03/30/2004 , VALUATION : $ 0.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A INSTALL A GAS WATER HEATER # ELEC WATER HEATERS # NEW FIXTURES (EXIST OPENINGS) # GAS DRYERS # OF NEW FIXTURES APPLICANT NORBLOM PLUMBING CO 2905 GARFIELD AVE S MINNEAPOLIS, MN 55408-2173 (612)827-4033 MICHELLE, BLAIR 40 66 1/2 WAY NE FRIDLEY, MN 55432 0 VALUE OF FIXTURE/APPLIANCE 400 0 # GAS WATER HEATERS 1 0 # GAS RANGES 0 0 # WATER TRMT APPLIANCES 0 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Appli Date Bldg Ins Dat PLBG PERMIT MINIMUM FEE 20.00 PLBG FIXTURES (NEW OPENINGS) 0.00 PLBG FIXTURES (EXIST OPENINGS) 0.00 WATER TREATMENT APPLIANCE 0.00 WATER HEATER - ELEC 0.00 WATER HEATER - GAS 0.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 PLBG REPAIR/ALTERATIONS 0.00 STATE SURCHARGE, PLBG FLAT 0.50 TOTAL 20.50 PAID WITH CHECK # 28035 N V YAKA 11✓ YL' K1V111 N 1(1:,11 U 1K1;1J r UK W V K& V 1 ri r.K 1 r 1111 1J1;31.K1DD1J AD V V >J. CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE FridleyJAN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On Jan 1, 2000 PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** Cas Range*" NO. RATE TOTAL JOB ADDRESSfliF d -s tSt, OIE3 IZ "76 &PI 'a � / Gas Di yer** _ Back Flow Preventer Required ( )Yes (} No Type - $ 7.00 The undersigned hereby makes application for a permit for the work herein $ `,.00 specified agreeing to do all work in strict accordance with the city codes $ 5.00 and rulings of the Building Division, and hereby declares that all the facts $ 7.00 and representations stated in this application are true and correct. $ 7.00 $ 7.00 GLAIR, MICHELLE 40 66TH 1/2 WAY NORTHEAST $ 7.00 FRIDLEY, MN 55432 $10.00 Owner_ (763) 574-7431 $ 7.00 $10.00 Building Used As 611>okj cz $10.00 _ $10.00 0 Estimated Cost � _ PERMI i NO. l%o&'6 n auna&4 $15.00 PLUMBINGCOMPANY / Reinspection Fee $47.00/Hr SIGNED BY - TEL N0. ;.7t_ _ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance Approved By Rough -In Date Final Date State Surcharge $ .50 MINIMU-M FEE %�QIIR ANY PLUMBINGIGAS PERMIT IS $20.00 TOTAL FEE $ _50 PLUS THE S.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, 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 $ 1/f. 2S BUILDING Plan Review Permit No.• 65% of Building Permit Fee Fire Surcharge $ 14,400 .001 times the total job valuation Surcharge Inspections .0005 x Permit Valuation Minimum $.50 RESIDENTIAL APPLICATION $ "'5 GZ% Received By: 763-572-3604 $ $1675 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow DatPdA p R 1 2007 ft + 6 ft = ft x $21 =$ Erosion Control CITY OF FRIDLEY $450 Conservation Plan Review Park Fee DATE YOUR E-MAIL ADDRESS Sewer Main Charge SITE ADDRES -- r LLIQ 14 IJ L Total Due THIS APPLICANT IS: ❑ OWNER MeORTRACTOR PROPERTY OWNER/ NAME: M -t rel DRcA HANstLtj TENANT ADDRES . ®l.,&t/Z WAY AIC— CITY F7R I D L -C z i STATE ZIP�j�2 PHONE `' g=G CONTRACTOR NAME: it o 2-ro s i r't_ STATE LICENSE # ZO 1:7 Z-(,, k —] EXP DATE 317, 1 � ZUOg SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: f o3 -j I (Yl ON R o 9- ---,'i— NJ CITY STATE ZIP WITH APPLICATION PHO 7(0 - 50 Z fob FAX PROPERTY TYPEWGLE FAMILY W CONSTRUCTION SIZE ❑ TWOTAMMTI EW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED Cit -WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAW TILE ❑ DECK GSIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION f4IAINTENANCE/REPAM ❑ REMODELING DESCRIBE WORK BEING DONE: &0JOCe Lt) (1//CYLol iL Oka K2 br r vin SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING U'ROUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. 2• Existing Floor Plan 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 GFTrim 1. Site Plan/Survey showing the existing structures ❑ Other . ❑ Fascia and proposed project. WINDOWS/ 2. 3. Two sets of construction plans Energy Calculations IN EXISTING OPENINGS fr'i'es [No LOCATION OF WINDOWS 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 THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ q 090 OCCUPANCY TYPE Permit Fee $ 1/f. 2S See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ 14,400 .001 times the total job valuation Surcharge $ a -A V .0005 x Permit Valuation Minimum $.50 License Surcharge $ "'5 GZ% $5.00 (State Licensed Residential Contractors) SAC Charge $ $1675 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21 =$ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ 72 A, 7-7 Make checks payable to: City of Fridley Attach Stipulations THIS IS.AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I here b apply for a building permit d I acknowledge that the information above is complete and accurate; that the work will be in confo ance with the or ' es an co e City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit t only an ication for a perm and ork is not to start without a permit; that the work will be in accordance with the approved plan in the a of a work which requ' s r ie and approval of plans. SIGNATURE OF APPLI PRINT NAMIO GO - DATE; >' �7 i Building $ BUILDING Plan Review Permit No. Inspections Fire Surcharge RESIDENTIAL APPLICATION O e '70 .001 times the total job valuation Received By: 763-572-3604 .0005 x Permit Valuation Minimum $.50 CITY OF FRIDLEY $ -� $5.00 (State Licensed Residential Contractors) DATE YOUR E-MAIL ADDRESS $1675 per SAC Unit (Plans to MWCC for determination) SITE ADDRESStYlrl,? $ ft + 6 ft = ft x $21 = $ THIS APPLICANT IS: ❑ OWNER Ii1C0NTRACTOR $450 Conservation Plan Review PROPERTY OWNER/ NAME: MAg K HA AiSoM Fee Determined by Engineering TENANT ADDRESS:�(� (n ,!&VVA y N j:�, CITY 4791 DL STATE 'VIP 5-5t['3 2— Total Due PHONE: PHONE: Make checks savable to: City of Fridlev Attach Stipulations CONTRACTOR NAME: = EI Tt/S/,O ' s/ STATE LICENSE #_ -20i-72G,-:R-7 EXP DATE 4/1/OF SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS:- 6+ 91 f'Y nhieo l= Si A 1E. CITY (Z1 �'D - STATE ZIP 3'Z WITH APPLICATION PHONE 3 - - (o " FAX PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED WS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: ltd GI~ im 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 F..Krim I. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project WINDOWS_ 2. Two sets of construction plans IN EXISTING OPENINGS lyes ❑N 5 LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBES OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED MQ NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ ® OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ O e '70 .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge $ -� $5.00 (State Licensed Residential Contractors) SAC Charge $ $1675 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ Make checks savable to: City of Fridlev 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 which requires review and approval of plans. SIGNATURE OF APPLICANT RINT NAME DA ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION $ 3 S 00 OCCUPANCY TYPE Permit Fee $ BUILDING Permit N0.2�— Buildilag Inspections Fire Surcharge RESIDENTIAL APPLICATION Received By: 763-572-3604 $ , CITY OF FRIDLEY Date Rec'4 763-50L2-4977 FAX $5.00 (State Licensed Residential Contractors) SAC Charge $ $1825 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow EFFECTIVE 1-1-08 ft + 6 ft = ft x $21 =$ DATE �1 I l C° 108 YOUR E-MAIL ADDRESS M C "Vl S ev1 e S f -0A S v (fi ( 0 -C_ o rPn SITE ADDRESS N Z) h)e-- Park Fee THIS APPLICANT IS: I1P6WNER ❑CONTRACTOR Fee Determined by Engineering PROPERTY OWNER/ NAME. ,:�Lr L Ors p sL ✓1 Agreement necessary ( ) Non Necessary ( ) TENANT ADDRESS: �� Csl��y lA)".y Nom— CITY �� ���/ STATE MIII ZIP SSy37 PHONE: NAME: ADDRESS: CITY STATE ZIP CONTRACTOR SUBMIT A COPY OF PHONE FAX YOUR STATE LICENSE STATE LICENSE # EXP DATE PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILYINEW CONSTRUCTION STORIES PERMIT TYPE ❑ VDITION ❑ GARAGE/SHED INDOWS RSASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK:❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR OWEMODELING Kem INIenF' DESCRIBE WORK BEING DONE: oc e SIZE OF IMPROVEMENT �- LENGTH t 7' WIDTH i e HEIGHT S FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used. PROPOSED HEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING ADDITIONS & PORCHES SUBMIT: ❑ Vinyl ❑Soffit I. Site Plan/Survey showing the existing structures ❑ Aluminum ❑ Trim and proposed project. ❑ Other ❑ Fascia 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 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 THE 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION $ 3 S 00 OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ -2 .001 times the total job valuation Surcharge $ , .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1825 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21 =$ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ n Make checks payable to: City of Fridley Attach Sti ulations 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 onstruction des; that 1 understand this is not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in actor ce ith the oved plan in the case of all work which requires review and approval of plans. SIGNATURE OF CANT L t PRINT NAME Ma'L rl Cis'► Se-\ DATE L( b (' 06 APPROVED BY `.1. J'a iTNA &InUA DATE �� `� THIS -JOB COPY SHALL BE � AVAILABLE �N THE Si-�v FOR THE FRAMING �� AND FINAL INSPECTIONS FLAT PANEL TV WINDOW WINDOWIII [10TITRITI lIT[=Il 11 111111111111111 CLOSET �� ( "�-��,yL�N �j{14��£� W` `►l EXISTING BAR � (TO BE REMOVED) P?�Sb\&4w - BUILT IN BOOK �SHELF j 17- y�� , HOf100 Wry �� �IZ( Wttt�• ` 1► ���'`� �'�� o STAIRS DOWN G7 �aS��31"1e^1 H WINDOW STAIRS UP 28" DOOR ACCESS TO BATHTUB _—__--_--- TPLUMBING BELOW � STAIRS UP TO KITCHEN PROPOSED WALL \ EXISTING WALL BATHTUB: 72"x60"x30" —^ !c Std Sv S �,� `' +rv►•N—�0►1�.` c(�1zc c.f. vqk I TOILET fit,,�(, O� FLOOR PLAN ING ACCESS %+ 1 = 5 1 An ML SINK (F09� }_. W i`i�f 4 tki %Q �r1V� ii S C®1Y PLIA CE LuAl 0A C�ewa6li W tNCZw • BLDG Ins- os / q - 4f, A/ V 0 8 Building PLUMBING PD".`' Inspections RESIDENTIAL APPLICATION _ Received By 763-572-3604 CITY OF FRIDLEY Datg� 763-502-4977 FAX �d: EFFECTIVE 1-1-08 42 DATE -I 2 YOUR E-MAIL ADDRESS G �Ck✓t Se n e- 5 f-'�C On 5� (+1 SITE ADDRESS �J vC�z W0.y NL Fr�C��ey� rAij .5 THIS APPLICANT IS: Q OWNER ❑CONTRACTOR PROPERTY NAME: m a- L N CL vt S e ✓l ADDRESS: yd CsCs z tlJaY f�2 CITY Fr% -A" STATE Ml'1ZIP SS'132 TENANT PHONE:_? &3 - qq 3- c`7 Cot L{ CONTRACTOR NAME: A) ( A SUBMIT A COPY OF YOUR STATE STATE LICENSE # EXP DATE LICENSE, BOND AND STATE BOND # EXP DATE CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE PHONE FAX PERMIT TYPE a<INGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: �E' O REPLACEMENT DETAILED DESCRIPTION OF WORK Q0.A ra a m 2 nn 0.1e 1 vj v—k i s -4- t 21 ho me- in S+*.11 'k -o b 1 S k e w -- PER MS 1613.665 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 = plus .50 surcharge OR FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL OF EACH BELOW). MINIMUM FEE $15.50. W. ATH SINK/LAV DRAINS SHOWER WATER PIPING _FLOOR _ _ _✓BATHTUB —GAS PIPING (NEED CITY LIC) _ SWIMMING POOL _ WATER SOFTNER ($35) _ CLOTHES WASHER _ KITCHEN SINK _ WATER CLOSET _ BACKFLOW PREY. ($15) _ DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION WATER METER OTHER 'ERT FEE PROJECTS FOR UNIiER:SS4t? Mi PERMIT FEE FOR PROJECTS OVER Permit Fee $ Number of fixtures @ $10.00 Z x$10.00=$ Z o o o Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ OR Number of fixtures @ $35.00 x $35.00 = $ TOTAL DUE $ State Surcharge = $ .50 MINIMUM $15.50 MINIMUM $15.50 Total = $ z v. -5-6 THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a plumbing 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,pe}mit and work is not to start without a permit on site; that the work will be in accordance with the approve an in the�,�se of all wp which requires review and approval of plans. r SIGNATURE OF APP) ICA T ` ��� PRINT NAME M Q r t t 4nS C h DATE Z $ $ APPROVED BY DATE L,_:. PLEA E NO'MSE TE' RMITS ARE REQUIRED FOR I i,II .,DIN ELECTIiICAL'AND=MECHANICAL' ORK City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-5024977 City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 PLUMBING Permit Na.: Building Inspections RESIDENTIAL APPLICATION Received By• l, 763-572-3604 CITY OF FRIDLEY Da'd:l I I 4 inn 763-502-4977 FAX EFFECTIVE I-1-08 Arl 3v I'( DATE 7 ' 1uOR YOUR E-MAIL ADDRESS M C_ kdLV1 SCn C 94-c-ar' M 4 . core' SITE ADDRESS Y ® Z Qc,yA)(_0AFr I J le-V m /y $ s,4*3Z THIS APPLICANT 1S: WOWNER OCONTRACTOR PROPERTY NAME; of r k- a'S G ✓7 ADDRESS: cI ® & & �,L. Wol Me— CITY Fri I t v STATE/IW ZIP 5544 37— ZTENANT OWNER/ TENANT PHONE: CONTRACTOR NAME: STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE, BOND AND STATE BOND # EXP DATE CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE . PHONE FAX E! J"NGLE FAMILY O TWO FAMILY O TOWNHOUSE PERMIT TYPE O NEW R'REPLACEMENT TYPE OF WORK: DETAILED DESCRIPTION OF WORK 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 = plus .50 surcharge OR FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $15.50. BATH SINK/LAV FLOOR DRAINS _ WATER PIPING —SHOWER —BATHTUB _ GAS PIPING (NEED CITY LIC) _ SWIMMING POOL _ WATER SOFTNER ($35) CLOTHES WASHER KITCHEN SINK _ WATER CLOSET _ BACKFLOW PREY. ($15) _ _ DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION WATER METER _OTHER `"4 y$i a' :.sa� �' ,.:. '� ... F ... 110,10 RI . .:� a�.kT.`t.-m`$� Permit Fee $ t S . oo Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ ! 5,-. S o OR Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $`50 (MINIMUM $15.50) (MINIMUM $15.50) Total = $ THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a plumbing 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 applic tin for ape and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the of iI wo ich requires review and approval of plans. M aric- �h S� DATE 7 �I q 16% SIGNATURE OF APPLICANT U PRINTNAME APPROVED BY DATE kil City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Building MECHANICAL PermitNo.:Wo, Inspections RESIDENTIAL APPLICATION Received By: ffah 763-572-3604 CITY OF FRIDLEYU w �q 763-502-4977 FAX EFFECTIVE 1-1-OS DATE I C'/ & l o$ YOUR E-MAIL ADDRESS M C "` a n SC n C 5r _"VI S v I t" q, C o w1 SITEADDRESS 110 /V e- f r,Jt,—X MAJ 5 S y 3Z } THIS APPLICANT IS: OWNER ❑CONTRACTOR PROPERTY NAME: MCLTk HCLA Se vI ADDRESS: '4 D —,% 1V e CITY Fri (eTATE /2gj ZIP L;_6 N 32. OWNER/ TENANT PHONE: i6o 3- y Y 3_ S& 1 y CONTRACTOR COMPANY NAME: NOTE: SEPARATE CITY CONTACT PERSON: STATE LICENSE # EXP DATE LICENSES ARE REQUIRED FOR GAS AND HVAC. ADDRESS: CITY STATE ZIP SUBMIT COPY OF BOND PHONE FAX ANDINSURANCE PERMIT TYPE �/� CTSINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: 2'FEW ❑ REPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK J-+1 Sfti<< a-F-1 O V\ o ( -F re l ce- 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) OR 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) Equipment Installed MFG: MODEL: SIZEIBTU MFG: MODEL: SIZEIBTU MFG:��� MODEL: SIZEIBTU $25.00 ;; IREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 _A/C TO AIR EXC14ANGEER $15 (WOOD) $35.00 NEW GAS GRILL $10.00 _AIR _FIREPLACE $35.00 $35.00 _GAS UNIT HTR $10.00 _BOILER _FURNACE LINER $10.00 DRYER $10.00 _POOL HEATER $35.00 _CHIMNEY _GAS WORK $10.00 GAS PIPING $10.00 _VENTILATOR $15.00 _DUCT FEIMII I'I P':171�..Woff WE 0 Permit Fee $ Is- . oa Number of fixtures @ $10.00 x $10.00 = $ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ /T . S b OR Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 MINIMUM $15.50 MINIMUM $15.50 Total = $ THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a mechanical 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 withthe a to Co ction 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 bei r ce a approved plan in the case of all work which requires review and approval of plans. OF PRINT NAME Met - 14 Vl �1 3-e el DATE 10 LGLOR SIGNATURE APPLICANT APPROVED BY DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 _—- `- , , From: 7637854937 Page:/2 � Date: 10/17/2008 8:37:46 AM� Building MECHANICAL PermitN , ()06`0'70 Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 ,- CITY OF FRIDLEY as C 763-502-4977 FAX EFFF.GTIVF I•I.OR �R DATr YOUR E - MAIL ADDRESS rl L?Yi..W04 SITE ADDRESS TL -US APPLICANT IS. 13 OWNER *ONTRACTOR PROPEWl'Y NAME. ffitu -V J -h 14 VE 11 OWNER/ TENANT ADDRESS: Sii.1 LAI ab OkIN CITY STAT F_YJP PHONE: CONTRACTOR COMPANYNAME: NOTS; SEPARATECITY CONTACT PERSON: L1CIdNSCsS ARE RF.QUIRRI) FOR GAS _ STATE LICENSL b ID(p DATE !! AND HVAC. ADDRESS: 1 CITY STA'rhAMjP` 5CV SUBMJTCOPYOVUOND _ PHONE I FAX ANDINSURANCE PERMIT TYPE [PNOLh FAMILY I7'I vVU I"AMILY ❑ TOWNHOUSE TYPE OF WORK: auw ❑ REPLACEM FAT 0 AurERA'rION/R1::MODEL DETAILED DESCRIPTION OF WORK PER MS 16B.665 the permit fee is a minimum of $I&W or .4% of the total cost up to $500.00. whichever is greater, for the improvemem installation or replacement Ora residential fixture, excluding the fixtures. MIS should reflect only the cost of labor) OR Labor cost under 5300 = S 15.00. Labor cost between $300 to $500 = cost of labor..., 00 x.05= 15 • b� 1101t PROJECI'S WHERE LABOR EXCEEDS $5W, FEES ARL BASED ON 510.00 PER PICTURE, I:XGh.'I'I' WHERE NOTED. FIXTURES. (INDICATE'I'O'rAL N1JMTlrR OF IlACR nrI,OW) IAuipnvnt Installed MFG: MODEL' SIZCIBTU MFO: �+ MODEL: S17PJM "U• MOLML. SIZEtHTU _A/C$?.S.00 _ P101,PLACII(GAS)$15IN) PASRANGLYOVEN$10.00 AIR TO AIR LEXCHANOEER $IS FIREPLACF, (WOOD) $35 00 NEW GAS GRII,I. $10 00 _HOILER $35.00 FURNACE $35.00 UNIT I•ITR $10.00 �GAti — CH1MNRY 1.1NRK $10.101 CTAS VKYUK$10.0(1 POOL I1EATI:R 135 00 DUCTWORKSI0.00 _GAS PIPINC$10.D0V13N'rILATOR$1500 PERMIT FEE PROJECTS FOR UNDER $500 .PERMIT FRE FOR PROJHCTS OVER $500 ftrrnit F $ Nuinbcr of flxtures ® $10.00 _ x $10.00 v $ Surcharge 0 Number of fixtures (" ia, $15,00 x $15.00 = $ __ TOTAL. DUF $ � _ OR Number of fixtures a $25,00 x $25.00 = _ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $,!„- .50 MINIMUM S1&50 MINIMUM W.S0 Total =S THIS IS AN APPLICKI"ION FOR A PER -NOT VALID UNTIL PROCESSED I hereby Apply far a moclnmlcnl permit and I acknowledge that the infon►mtion abo camplato and accurate; that the work will be 1n. conrarmarne with the ordinances and cadcs of ft City of Fridleyy and wi to Constniction C Is; that .understand this is not a permit but only on application for a pennit and work is not to nlviow�ni q{rproval of pinn9. soul wiltwut n peimil, shut the work w' tx with l u pl n the case of all work whichU��UAJQ?AATF.Lb/aff SIGNATURE OF APPLICAN PRINTNAME APPROVED BY DATE PCF AM NOTE: SEPARATE, PERMITS ARE RE UIRCD'FOP. BUILDING, FIXICTRICAL AND MECHANICAL WORK City of Fridley Building Tusliectionx Delmnizacnt 6431 University Avenue NE. Fridicy, MN 55432 763-572.3604 !'AX: 763-502-4977 M E