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PRE 2010 DOCS• 0 Village of Fridley, Minn. 0 o° '' BUILDING PERMIT 1824 Date: .... .......'j ..r�......... . Owner....................................... Builder .. Address...................................... Address ..... 6! x./..7.... 4yI {�'o �`LOC�ATION OF BUILDING No. t3..rr / .... Street .....J... f ................ Part of Lot ........ ............... . r � ,y4 Lot ....nNi........ Block ....... G........ Addition or Sub -Division . !/ .�t . `r......... !........ ... . Corner Lot .... t ...... Inside Lot ........... Setback .... Sideyard ... DESCRIPTION OF BUILDING To be Used as: : .. ...... Front :0Y Depth .. Height . :4. Sq. Ft. ........ Cu. Ft. ........ ........... Front . 0�;-... Depth .. Height . �. Sq. Ft. ........ Cu. Ft. ........ Type of Construction ..... Est. Cost ....... To be Completed .................. In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the village of Fridley. e F� i�-..................................................... �,J/,///!j/n, .X iri✓ 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 with— in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. g ........ .. .... Building Inspector NOTICE: This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separd'Wpermits for these items. NO lt'A' d1p A _.!`'_.R - .1 5 6 W, # • • r -r --I LJ Date: July 269 1965 City of Fridley, Minn. BUILDING PERMIT Builder WESTERN Ham? INC. N° 8266 Address 541 - 67th Ave. N.E. Address 10051 Grouse St. Fridley, Minnesota Coon Rapids, Minnesota LOCATION OF BUILDING No. 541 Street 67TH AVENUE N. E. Part of Lot Lot _ 3_ _ Block 6 Addition or Sub -Division RC. Terrace, Plat 4 Corner Lot _ Inside Lot Setback 30 _ Sideyard 10 Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Parsonage Front Depth Height Sq. Ft Cu. Ft. Front Depth freight Sq. Ft Cu. Ft Type of Construction Fat. Cost $3 0 x 000.00 _ To be Completed REBUILD * STCHM DMAGE 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 eel forth and in comp with aft provisions of ordinances o the city of Fridley. In consideration of the payment of a fee of $ 10•0 , permit is hereby granted to WESTERN H(Ms INC. 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 Fwithin ridley, Minnesota �1 i� bei �alteration,atime upon violation of any the provisio s off ordiinanceess. city limits and A=N G. JENSEN Building InqXWtor NOTICE: 7W permh dos net sorer the ewidruetion, butailation for vArin& phtmbine, 6u h*dhm sewer er water. Be wre to see the Building lagaetor for separau permfh for these hems. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME BUILDER �I�� ADDRESS ADDRESs�c��. Pe�-e� S Fz a LOCATION OF BUILDING NO. STREET -,� of If, PART OF LOT LOT j_BLOCR ADDITION OR SUBDIVISION 1� CORNER LOT I-,-- INSIDE LOT SETBACK '30 SIDE YARD ID SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. To be used as; R DESCRIPTION OF BUILDING Front S )L- Depth 33 Height Dim./ i Sq. Ft. I �--K Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost (' 5c, &k4 -e To be completed_ j The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE % a 4 P b (S SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side City of Fridley SUBJECT 14161 AT THE TOP OF THE TWINS BUILDING P E R M I T r RE PT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY ' 612-571-3450 910-F15 5/10/96 JOB ADDRESS 541 67 Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 6 SHEET 1 Rice Creek Terrace Pat 4 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Randy Manderschied 541 67 Avenue NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. All -Ways - 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20003805 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 237.5 Sq Ft Deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. WAR1 Before digging digging call J f ora!! Utility00twns R452 EQF?r-uBYLAW SEPARATE PERMITS R���i�E� WIRING, HEATING, PLUNUNG AND S4GN& SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 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 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,035 $1.02 DOES NO PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVIS N OF ANY OTHER STATE OR LOCAL LAW REGULATING CON - Fire SC $2.04 U 0 OR THE PERFORMANCE O CONSTRUCTION. $74.75 - PLAN CHECK FEE 1482.81 ALFEE Licen SC .00 SIGNATURE OF CONTRACTOR OR OR D GENT IDATEI PR Y VA ID THIS ISYYOUR PERMIT 45 ) ~ //- V �OAATE S,GNATURE OF OWNERIIF OWNER BUILDERI IDATEI DG INS A 01 NEW [ ] Effective 3/1/96 ADDN [ J CITY OF. FRIDLEY ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ' G ConstructionAddress: tplk A s e. U� k -e-r Legal Description: $.50/$1,000 Valuation Owner Name & Address: 12An& u MCk Yet e yZ sch 14 Ck Tel. # Contractor:-, (-� C1 L MN LICENSE # JL 600 � Address: , _ OL ; kkA �-Si I).Tel. # 0-9& - / ,QS 1 Driveway Escrow Attach to this app ication, a Certificate of Survey of the Alt. "A" or Alt. "B" Above lot, with the proposed construction drawn on it to scale. $ DESCRIPTION OF EUPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length 90 Width 10 Hgt/Ground Sq. Ft. OTHER: $ . Z ' Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction:L. ' Estimated Cost: $ Approx. Completion Date: (Cost on Back) Driveway b Cut Width Needed: t. + Ftt x $ _ $ DATE: '1 APPLICANT: Tel. # f CITY USE ONLY Permit Fee $ y %1 Fee Schedule on Reverse Side Fire Surcharge $ 0, dY .001 of Permit Valuation (1/10th%) State Surcharge $ 4 d?- $.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 Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary ( ] Not Necessary [ ] TOTAL $ . Z ' STIPULATIONS: ,M -ilia IPs Decks, Inc. 310 Wexford Heights Dr. New Brighton, MN 55112 License #20003805 JOB AD ESS T��sjy M4,V10$c k .- SSgi (z,7% fig. n F OX Footings will be 42° deep, 12" diameter • Rail height 36" min. • Step rise will be 8t "ax. will Structure will be 2 x 10 GT Z.Ii " OC-• Rail space 4'lmax. posts will be 6 x 6 Decking will be cedar • Step run b 9" min. Y � � SUBJECT P of Fridley '24220 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. Ir?City Iiw` ____--_ COMMUNITY DEVELOPMENT DIV. y ` ^ r PROTECTIVE INSPECTION SEC. 1 � � NUMBER REV DATE PAGE OF APPROVED BY /'--1 CITY HALL FRIDLEY 55432 ,.j 612-571-3450 910-F15 5/30/96 JOB ADDRESS 541 67 Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 6 1 Rice Creek Terrace Plat 4 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Xxv Randall Manderschied 541 67 Avenue NE 566-9923 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Advanced Home Improvement 1501 78 Ave W, Brooklyn Park MN 55444 566-0233 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20017269 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE R 8 DESCRIBE WORK Reroof House (18 Sq) 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 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 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 $1,440 $.72 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 $1.44 STRUCTION ORSHE PERFORMANCE OF CONSTRUCTION $48.50 L PLAN CHECK FEE TOTALFEE License SC $5.00 $55.66 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI WHEN))OPE VALIDATED THIS IS YOUR PERMIT 'SIF d BL MSP DATE SIGNATURE OF OWNER OF OWNER BUILDER] iDATEI NEW [ ] Effective 3/1/96 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 j1 Building Permit Application ConstructionAddress: Legal Description: Owner Name & Address: 7 e.(� —,,+L), / 01 76- � a , n,- MI-/ c- / Tel. # f Contractor: / uc� t-e� fig -e ,�,�R ,,, , -f- MN LICENSE # ;Z Go C -7.2& Address;/Q Tel. # S-9 6, - a 3 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: Length DESCRIPTION OF HAPROVEMENT Width GARAGE AREA: Length Width DECK AREA: Width OTHER: f rr%'C 7� f �- Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Type of Construction: Approx. Completion Date: �g-/30 A a Height Sq. Ft. Height Sq. Ft. Hgt/Ground Sq. Ft. Side Yard Setbacks Estimated Cost: -4 r (Cost on Back) Driveway Curb Cut Width Needed: Ft. + , Ft = Ft x $ _ $ DATE: s -o lr, e, APPLICANT: Tel. # gym -,Z 7 Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge $ S --on Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $900 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] 81iViJWmit1EiAAND Limn S HEATING HOUSE HEATING TEST RECORD RECORDCONDMONING `J Fan Setting ELECTRIC. INC. Pilot Type ADDRESS s� A/"i APT. FLOOR CITYSUBURB OCCUPANT fd jb Sec. OWNER Scram HEAT LOSS DATE HTG. INST. SOLD BY /aila,r+e �%�c_ �- iii INSTALLED BY %�la�s..� �% A—.4)J` Electrical Work By a /L On Una By 23&ja TYPE OF HEAT GA FA _(,, HW EAM� SPACE HTR._ UNITHTR OTHER OAS DESIGN MAKE«a� Model Serial i 117 3) 3 INPUT CONTROLS THERMOSTAT Heat Plug Valve Limn S �et�co Limit Setting `J Fan Setting ,2 Pilot Type to ea Pilot Make A/"i Pilot Model Pilot Timing jb Sec. L W. Cut Off CONVERSION MAKE OF BURNER us" Max. BTU Rating MAKE OF FURNACE Model Vent sin S KIND OF LINER A rmr. SIZE S NONE Draft Hood:. .1 Regulator Filters sin Tr Number / Chimney Loostion Inside Outside Chimney Construction "o A r — Smoke Bomb Wiring Dreg Teat Tag Door Pressure Lighting Inst. e Pressure 3 • S Percent CO, Date Tested Input CFH Percent O, Company Testing Stack Tamp. Percent CO Name of Tester �3 Form 235 "CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 RATE SCHEDULE Residential APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING -SYSTEMS AND DEVICES Furnace Shell and Duct Work, Burner — Also Replacement Furnace (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) Gas Range Gas Dryer *Air Conditioning — All Sizes All Others/Repairs & Alterations (LIST ON BACK I% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Effective On January 1, 1997 JOB ADDRESS q 1 07 f --t-) PVP Ale State Surcharge TOTAL FEE 50 $ ;MD MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Burner Trade Name Size No. BTU HP EDR BLAINE HTG. A/C ELEC I., 13562 CENTRAL AVE. N.E HEATING CO Y ANOKA, MN 55304 Signed Approved By Rough—in Date Final Date FILL OUT BACKSIDE FO STACK VERIFICATION ON 3�w REPLACEMENT FURNAC The undersigned hereby makes application for a permit for the work herein Rate TOTAL specified agreeing to do all work in'strict accordance with the City Codes and rulings of the Building Division, and hereby declares that all the facts and $ 30.00 $�C� representations stated in this application are true and correct. ,1997 $ 10.00 $ WNER OWNER.- $10.00 $10.00 $ BUILDING USED AS $10.00 $ ESTIMATED COST PERMIT N0. !2!2Z/- $25.00 $ DESCRIPTION OF FURNACE AND OR BURNER $ No, of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name ¢ Size No. BTU l DO l HP EDR $ Fuel Total Connected Load State Surcharge TOTAL FEE 50 $ ;MD MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Burner Trade Name Size No. BTU HP EDR BLAINE HTG. A/C ELEC I., 13562 CENTRAL AVE. N.E HEATING CO Y ANOKA, MN 55304 Signed Approved By Rough—in Date Final Date FILL OUT BACKSIDE FO STACK VERIFICATION ON 3�w REPLACEMENT FURNAC CH MNEY AND STACK VERIFICATION The undersigned hereby verifies that the -existing chimney or stack: 1. . Has been carefully examined Yes ( No ( ) 2. Is free from rust or deterioration Yes(M) No ( ) 3. Has no foreign objects lodged within Yes () No ( ) 4. Is securely supported Yes () No { ) 5. Meets all current Code requirements for size and total BTU's connected Yes (�) No ( ) 6 Has total heating BTU's of /001 All other BTU's 1-f6 U TOTAL BTU's J Ll 0 4® U U 7. Has a liner been provided for water heater Yes 66 No (. ) 8. Has combustion air been provided for water heater Yes (j) No ( ) Remarks: . List ALTERATIONS Being Done: HEATING CO: Signed By: Date: BLAINE HTGa. A/C ELECT., 13562 CW4TRAL AVE. N.E. MN 55304 0-7- Effective On January 1, 1997 6431 University Ave NE Fridley, MN 55432 APPUCATION FOR POWER PLANTS AND HEATING, COOUNG, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOBADDRESS`T RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential " Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner - rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 30.00 $ representations stated in this application are true and cot rect. (Side Vent - Fill Out Back) % D 1997 uas Piping (Needed with new furnace) V $10.00 $ OWNER Gas Range $10.00 BUILDING USED AS Gas Dryer $10.00 $ - -- ESTIMATED COST / PERMIT NO. ' *Air Conditioning - All Sizes $ 25.00 $ -i DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST ON BACK) 1 of Value of Appliance or Work $ D No. Heating a-� wU of Units- _ Circle One (Steamf (Hot Water) (Warm Air) Trade Name�,,;rm 0PrJQ Size No. Commercial/Industrial 01 LJ y2saa A-rl f'i HP EDR 1.25% of Value of Appliance or Work $ Fuel_ n Total Connected Load " State Surcharge $ .50 TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION L REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Burner Trade Name Size No. BTU HP EDR HEATING CO Y19f14'ix • /6wer-10ce-A . Signed Cy ® Tel No.71 eq I 0 Approved By Rounh-In Date Finai nate FILL OUT BACK SID OR STACK VERIFICATION ON REPLACEMENT FURNACE List ALTERATIONS Being Done. HEATING CO: Signed By: Date: SunsC6 �cE. ;prlr� CEUMNl ;Y AND STACK VERIFICATION The undersigned hereby verifies t iat the existing chimney or stack: 1. Has been carefully examir A Yes ()C) No ( ) 2. Is free from rust or deteri( ration Yes No ( ) 3. Has no foreign objects lod ;ed within Yes) No ( ) 4. Is securely supported Yes) No ( ) 5. Meets all current Code req iirements for size and total BTU's connected Yes ( No ( ) 6 Has total heating BTU's of All other BTU's TOTAL BTU's 3e.? ®®g� 7. Has a liner been provided t )r water heater Yes() No 8. Has combustion air been provided for water heater Yes () No Remarks• _ =I 4e. li A Ad- A List ALTERATIONS Being Done. HEATING CO: Signed By: Date: SunsC6 �cE. ;prlr� SUBJECT IT NO. City of Fridley 30760 AT THE TOP OF THE TWINS BUILDING PERMIT r R NO. COMMUNITY DEVELOPMENT DIV. r� I r i PROTECTIVE INSPECTION SEC. lJ 1 I I'j CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE Of APPROVED BY L 612-571-3450 910.F15 3/23/00 JOB ADDRESS 541 67 Avenue NE I LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 6 Rice Creek Terrace Plat 4 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Randy Manderschied 541 67 Avenue NE 571-4855 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Custom Pools 8960 Excelsior Blvd, Hopkins, MN 55343 952-933-2255 5023 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 J NEW 0 ADDITION 0 ALTERATION 0 REPAIR 0 MOVE 0 REMOVE 8 DESCRIBE WORK Install an 18' x-36' In -ground swimming pool 9 CHANGE OF USE FROM TO STIPULATIONS See notations on letter dated March 23, 2000. SEPARATE PERMITSdef®r� WARIV11% REQUIRED FDR; d ail utiigging call foe, tY locations WIRING UE AIG PLUAMQ AND Sift 02 REQUIR DDB RY LAW SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $5.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $11,000 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS ANY R S TE OR LOCAL LAW REGULATING CON- STRU THE NCE OF CONSTRUCTION $195.25 /� FireASC $11.00 fr ;'R�I PLAN CHECK FEE TOTAL EE License $5.00 16.75 SIGN4 URE OF CONTRACTOR ORAUTHORI DAGENT IOATE� EN D$ ALIDAT I$ IS Y UR P RMIT SNS. gAiE S,GNATURE OF OWNEROF OWNER BURDERi IOATEi NEW [ ] Effective 1/1/2000 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2{' BUILDING PERMIT APPLICATION 1 o \ VV� Construction Address: _S L4 ) (e r-7 Legal Description: Owner Name & Address: CY �+f' S Tel. # Contractor:ff MN IAddress: �(n C) �-> J , Attach to this applidation, 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: �� _ ��r,� �_�,�c� �� \ 1 P K - . 1 Construction Type: �>>+v, Estimated Cost: $ (, Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 2) APPLICANT Tel. # CITY USE ONLY - Call (763)) 572-3604 for Permit Fees if mailing in application Permit Fee Fee Schedule on Reverse Side Fire Surcharge .001 of Permit Valuation (1/10th%) State Surcharge $.50/$1,000 Valuation SAC Charge $ $1100 per SAC Unit License Surcharge $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL • "IS' STIPULATIONS: 1 OF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287 March 23, 2000 Custom Pools 8960 Excelsior Blvd Hopkins, MN 55343 RE: Swimming Pool Construction at 54167 Avenue NE, Fridley, MN Dear Sirs: This letter is to make clear this department's requirements for the swimming pool construction at the above address. 1. As indicated, two (2) skimmers approved by the National Sanitation Foundation will be provided. 2. As indicated, three (3) inlets of approved design for fresh and/or repurified water will be provided. 3. The filter and pump shall be approved by the N.S.F. and be of sufficient capacity to provide a minimum turnover of at least two (2) times in 24 hours. This department recommends a turnover rate of 6 - 8 hours. 4. A main drain of approved construction will be provided. 5. A deck of at least three (3) feet wide, measured from the pool waters edge, shall be provided which extends completely around all private residential pools. Above ground private residential pools may be provided with decking of a minimum size of 4 feet by 4 feet at pool entry points and provided that such decking has the approval of the City. 6. The diving area will be acceptable provided there is no overhead obstruction. 7. Fencing or other effective means including but not limited to walls or buildings, acceptable to the pools. Fencing shall meet the following criteria: a. The fencing shall prevent the entrance of children and be without hand or foot holds that would enable a person to climb over it. b. The fencing shall be at least 6 feet high and entrances shall be equipped with self- closing and self -latching gates capable of being locked. c. Self-closing and self -latching devices shall be placed at' the top of the gate or otherwise inaccessible to small children. d. The opening between the bottom of the fence and the ground or other surface shall be not more than four inches. March 23, 2000 Custom Pools Re: Swimming Pool Construction Page 2 8. An automatic chlorinator should be provided with a suitable test kit. 9. All electrical and plumbing installations shall be inspected and approved by the City Inspection Department. 10. All overhead electrical lines must be a minimum of 10 feet horizontally from the pool surface and 18 feet straight line distance from the waters edge. An alternative is to bury said lines. 11. The pool fill spout must be protected by a vacuum breaker or air -gapped. 12. Suitable safety equipment to include but not limited to a ring buoy and rope that is 1 1/2 times the pool diameter, and shepherds crook pole must be provided and maintained with the pool at all times. Furthermore, these and any other requirements must meet the provisions of the Fridley City Code, Section 115, Swimming pools. The building permit is approved contingent on final inspections and approval by the City. If any questions or problems arise from this letter, please contact me at 572-3603. Sincerely, DAVE JEN Building In: DJ/mh CC: Randy Manderschied, 54167 Avenue NE I I I I I i, I n ig 3(p 90 DEGREE CORNER FILLER A–FRAME DETAIL DECK SUPPORT DETAIL DIMENSION STRAIGHT PANEL .! Gott K"a n-nmK -B A O B 36, t FILLER 1 ANGLE 3/8'XI' NUT &BOLT Pala "'�"` K I N A T I P ME13'-4- N1 4 �o a we rLeAT te lmwt rRm uvc cmm" T� _i C E D L F � r SAND G H vt Juuu"[ K NOTE, DIMENSION C IS THE '�'� HEIGHT OF THE POOL PANEL. IMENSIONS E AND L ARE THE POOLS F NISHED DIMENSIONS. C D 3'-6# 3' — 4" F G 14'— 8' 4' _ 0" RIM C❑PING ' COPING CONCRETE PANEL DIVING BOARD SPECIFICATIONS — VATERLINE MINIMUM 8' DEEP WATER DEPTH '1I SLOPE H 12' J K L 18.0-00 RADIUS 14'-0" 10'— 0" 8`00 0" PANEL�LAYOUT LIGHT PANEL LAYOUT NOTES: M r 10'_0 2RSCP 8 8' 8' 8' RSCP 7'7" 7• 7, 2RSCP 8' 8' 8' 8' 2RSCP 2RSCP e' e' 8' 8' 2RSCP 3' 81 7 LIGHT 7, 3' 2RSC 8' 8' 8' 8' RSCP 1) THIS IS A TYPE II POOL IN ACCORDANCE TO N.S.P.I. STANDARD Of JAN. 1989 AND B.O.C.A. CODE - 1994 - SECTION 421. 2) ALL A -FRAME BRACES WILL BE MOUNDED WITH A MINIMUM OF 1 CUBIC FOOT OF CONCRETE. 3) MAXIMUM DIVING BOARD LENGTH, IS 8 FT. 4) 'NO DIVING' LABELS MUST BE INSTALLED N NI O 4'-0" 4'-0" 36-8 9/lf P Q R 14'-0" 32'-0" 2'-0" 8' STEEL STEP LAYOUT COPING LAYOUT 2RSCP 8 8' 8' 8' 2'R 8' 12 12' 2'R 2' 2- AROUND SHALLOW END OF POOL. S 2'—O" SPECIFICATIONS INTERP110L JRSCP B• � 12 12' :1 AREA: 644.57 SQ. FT. PERIMETER: 104'-6 13/16" 18' X 36' RECTANGLE WITH 2' RAD. CORNERS SATE' 02/26/97 SCALE: NONE 2RSCP 8, e. e' e' 2RSCP 2'R 81 12' 12' 2'R VOLUME: 24,461 GALLONS DRAWN BY: T F ACADRFF:F:IPIRu. — Features (cont.) outline DimeN/ons Media Kits • O-ring seals and hand tightened fit- tings have replaced gaskets and thread sealants at all bulkhead, drain and gauge port locations. • Top port allows for in -tank chemical treatment of media. Bushing and O- ring design helps prevent tank dam- age. • 'Tank base is integrally molded. Incorp nates leveling pads and mounting holes to facilitate all instal- lations. • Dramatically oversized drains are ori- ented for both side and bottom access. O-ring sealing plugs may be used as is or adapted for all piping and valving applications. Combination sand -or - water drain empties tank In moments. Materials and Design • Tank Glass reinforced thermoplastic Dura- Glas. Proprietary blend contains car- bon black for maximum outdoor aging resistance. • Clamps Plated and polished stainless steel. Designed with hand secured knob and stud assemblies. • Piping Connections Through -tank bulkhead fittings fea- ture full 2" diameter clear flow. Hand secured against O-ring seals, the bulk- head fittings allow for union style connection to any of the Sta-Rite slide or multi -position valves. • Tank Base Integrally molded with tank. Design incorporates leveling pads and mounting holes. • AirBleed Contains internal automatic air bleed, as well as top mounted air bleed at gauge port assembly. • Operating Limits Designed for maximum continual working, pressure of 50 psi. Water temFwrature maximum 105' F, Farm No 501PS (Rev. ?/92) System 3 _Sand Cal. No. A B ..... C 0 E S7S50 28 5' 42' 7 36' 53.5' SOS70 32.5' 42.25' 8 40' 54-25- A - 4.25' A- width,B - tklght.• C= number of clamps. 0 - area (width) needed to fake Off dX s•E=area (het 0 needed to remove top too o1 tank System 3 filters can cluinge from one media type to another within minutes, in many cases without disturbing any plumbing. Kit includes complete inter- nal assemblies, bulkhead fittings, oper- ating labels and manual. Consult customer service for Information Filter Drdering Information Catalog Filter Ship Wt. Carton No. Area (lbs.) Size M50 7.4 sq. It. S8S70 3.4 sq. Il •. "As we go to pass, this 11110111106011 IS notyet arailab/c. Filter Sizing Catalog Maximum Pool Size Pool Size Port Number Flow 8 hr. rate• 6 hr. rate* Size_ ,7$►i0 48 GPM 17,280-23,000 13,000-17,300 2' S8S70 68 GPM 24,480-32,640 19,000-24,489 2' • Sued on 15 to 20 GPM recommended flow rate range. Aceemory Ordering Information Catalog Valve Valve Body Valve Port Ship Wt. Number Type Material Size (lbs.) WC212-134P —_� — slide ABS 2' 4 WC212-136D slide bronze 2' 11 WC212-144P multiport ABS 2' 6 019915ta-Rite industries, Inc. - Sia-Ritc/a WICOR company Ordering Information High SF Nom. Low SF Nom. Catalog Number Port Size (FPT) High Service Factor Low Service Factor Model HP Model HP Max. BHP Volts Suction Discharge Wt. (lbs) ACCemory 16-5/16° Dura-Glas P2RA5FL 17-7/16" Dura-Glas 11 WR" Series P4RA6YGL Catalog Number Dimension A High Service Factor P2RA5CL 1/2 .65 115/230 1-1/2" 1-1/2" 32 Ordering Information P2R5CL 1/2 P2RA5DL 3/4 .95 115/230 1-1/2" 1-1/2" 35 P2R5DL 3/4 P2RA5EL 1 1.25 115/230 1-1/2" 1-1/2" 37 Suc. Wt. P2R5EL 1 P2RA5FL 1-1/2 1.65 115/230 1-1/2" 1-1/2" 43 Cat No. Description Size (lbs) Dura-Glas 11 Pkg.115 5" Dura-Glas Trap P4R6EL 1 P4RA6FL 1-1/2 1.65 230 2" 2" 43 w/Basket 1-1/2" 3 P4R6FL 1-1/2 P4RA6GL 2 2.2 230 2" 2" 49 Pkg.118 2" x 1-1/2" Dura-Glas Dura-GlasH/L Suction Adapter 2" 1 P2RA5YEL 1-1/5 1.25 230 1-1/2" 1-1/2" 41 U79-11 Lid wrench for 5" or P2RA5YFL 1-1/2-1/4 1.65 230 1-1/2" 1-1/2" 46 6" trap lids — 1 P2RA5YGL" 2-1/3 2.20 230 1-1/2" 1-1/2" 47 11201-0154-10 PVC Union 2" Male P4RA6YFL` 1-1/2-1/4 1.65 230 1-1/2" 1/1-2" 46 NPT x 2" Female Slip P4RA6YGL' 2-1/3 2.20 230 2" 1-1/2" 47 10 pack (for "1'4" only) — 10 -Capacitor Starl/Capacitor Run Motor '200 and 575 volt models available, consult factory. Outline Dimensions Dura-Glas WR" Series Catalog Number Dimension A High Service Factor Low Service Factor P2RA5CL 15-11/16" P2R5CL P2RA5DL 16-5/16° P2R5DL P2RA5EL 16-5/16° P2R5EL P2RA5FL 17-7/16" Dura-Glas 11 WR" Series P4RA6YGL Catalog Number Dimension A High Service Factor Low Service Factor P4R6EL P4RA6FL 27-1/8" P4R6FL P4RA6GL 27-1/2" Dura-Glas HIL "P2R4" Series Catalog Number Dimension A High Service Factor Low Service Factor P2RA5YEL 17-11/16 P2RA5YFL 18-3/8 P2RA5YGL 18-3/8 Note., P4RA6YFL 27-1/8 See Illustration 8J P4RA6YGL 27-1/2 CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 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: NO. RATE TOTAL New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin J Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** Gas Range** Gas Dryer** Back Flow Preventer Required ( )Yes () No $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 Type $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge $ .50 TOTAL FEE JOB The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. r '20 a0 Owner Building Used AsA6� Estimated Cost PERMIT NO. PLUMBING COMPANY SIGNED BY 4" l Y40 TEL N0. Approved By Rough -In Date Final Date � O 09 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 Appliance #2 Type Appliance #3 Type Total Appliances _ BTU Input _ BTU Input _ BTU Input Total Btu Input Fan Assisted or Nat Fan Assisted or Nat Fan Assisted or Nat 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: f CIiYOF FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (612) 571-3450 - FAX (612) 571-1287 July 14, 2000 Randall and Cheryl Manderschied 541 67th Avenue NE Fridley, MN 55432 Dear Mr. & Mrs. Manderschied: It is my understanding that on March 23, 2000, you were issued a permit to install an above ground swimming pool in your rear yard. It is also my understanding, that simultaneous with this request you constructed a fence along the lot lines of your rear yard which varies in height between 5 feet 4 inches and 6 feet in height (a permit is not required for a fence). The purpose of this letter is to inform you that while the height of the fence is in substantial compliance with City Code Section 115 pertaining to fencing around swimming pools, there is a technical discrepancy in the height of the fence which must be brought to your attention. Section 115.02.05 states that fencing "shall be at least six feet high". Because of the varying height of the fence, a challenge could be raised that the height of the fence is slightly shorter than six feet. The City will not require that you remove the fence; however, the City does recommend that you contact your insurer and confirm that the insurer is willing to provide coverage knowing the technical discrepancy regarding the height of the fence. I want to point out that the City fully understands that the nature of the varying fence height relates to the particular appearance of the fence. The varying height is a decorative attempt to make the fence look attractive. Also, because the fence is located along the property lot lines, the purpose of the fence is not only to meet the intent of the swimming pool code requirement, but also to be an attractive element as part of your property. The City does request that you provide information from your insurance carrier that coverage is provided for the swimming pool and required fence. Should you further questions, please do not hesitate to contact me at 763-572-3603. Sincerely, David Jensen Building Inspector cc: Barbara Dacy, Community Development Director B D\jt C-00-97 -Fle FARMERS INSURANCE 691 614AM tic R R GRCNIP �\ 07/18/00 CITY OF FRIDLEY 6431 UNIVERSITY AVE NE FRIDLEY, MN 55432 TO WHOM IT MAY CONCERN: RANDALL AND CHERYL MANDERSCHEID'S HOMEOWNERS POLICY WITH FARMERS INSURANCE COMPANY #908750773 COVERS THEIR LIABILITY UP TO $300,000 AS LONG AS THE POOL IS FENCED AND THE GATE IS LOCKED, THERE IS NO PROBLEM WITH THE HEIGHT OF THE FENCE VARYING BETWEEN 5'4" and 6' IN HEIGHT. I HAVE VERIFIED THIS WITH OUR UNDERWRITING DEPT IN AURORA, IL. IF YOU HAVE ANY FURTHER QUESTIONS, PLEASE DO NOT HESITATE TO CONTACT OUR OFFICE. THANK YOU. BETH WENTWORTH CUSTOMER SERVICE REPRESENTATIVE DUANE WALBERG AGENCY CC: RANDALL & CHERYL MANDERSCHEID Cl I Y Of I mm -t-1 I ivlV I11v 6431 University Ave NE V Adley. MN 55432 (763)572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NIIMRFR OF FIXTI n?t`(ZTn RC IKICTAI I cn nwl r.-. ,.�. Hlective Un Jan i. ZU02 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** Gas Range" Gas Dryer** Back Flow Preventer Required ( )Yes () Nc Type Reinspection Fee $47.00/Hr NO. RATE TOTAL JOB ADDRESS $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE 50 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the Building Division, and hereby declares that all the fads and representations stated in this application are true and correct. .2q Building Used As Estimated Cost — PERMIT NO. 68 COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A, COMMON VENT INFO ON BACK SIDE I ""` PLUMBING COMPANY Z22.,e== SIGNED BY TEL NO.CGtS/— 7� FAX # d — — Approved ByRough-In Date Final Date MINIMUM FEEOR ANY PLUMBING/GAS PERMIT IS 20:00. PLUS THE $.50 STATE SURCHARGE - ? COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A, COMMON VENT INFO ON BACK SIDE I ""` THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED When , 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 manufacturers specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The existing nnmhustien air is sized and installed to meet the current codes and manufacturers specifications. Yes () No ( ) When required to install a new cemhi,stion aIr. it will be sized and installed to meet the current codes and manufacturer's specifications. Yes( No( ) When installing a new y nting sy tpm, 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. ApolianrmTYpand Size/Common Vant Vent Yes( )No( ) and onn c-tnr Informatinn 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 HEATING CO: Signed By: Date : CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 Ol Otis 096 ;? 7 Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved by Rough -in Date Final Date Sq ` C 1 'Al� JOB ADDRESS O RATE SCHEDULE _ Fee Total Ian o Residential Owner Furnace Shell and Duct Work, Burner & also Replacement Furnace $35.00 $ 2S• Q© Building Used As Gas Piping (New Furnace, Fireplace, Insert) $1000. LC.00 ESTIMATED COST H3 O PERMIT NO Gas Range .00 $ DESCRIPTION OF FURNACE AND BURNER Gas Dryer $10.00 $ # of Heating Units 1 Circle One (Steam (Hot Water) (Warm Air) Trade Name e&�C)cs—r'IA Size No. Dg0 *Air Conditioning -All Sizes $25.00 $ BTU cz::� HP EDR Fuel Total Connected Load All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work $ Burner Trade Name Size No. Minimum Fee $15.00 for Residential or 5% of cost of BTU HP EDR Improvement whichever is greater The undersigned hereby makes application for a permit for the work herein Commercial/Industrial/Institutional specified agreeing to do all work in strict accordance with the City Codes 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/IndustriaVInstitutional and representations stated in this application are true and correct. State Surcharge HEATING CO . �-' .Q 4X63- S r-1 TOTAL FEE $HS. ® Signed Tel # REINSPECTION FEE $50.00/HOUR FAX # r7C 57(o - %o-Rc? Date �//6el-015' *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE 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 replacing an existing fumace, 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:O-kaly)�� Signed By: e Date:.�, Building PLUMBING Permit No.: a Inspections RESIDENTIAL APPLICATION Received By 763-572-3604 CITY OF FRIDLEY Date RecREn R N DATE 1-2-0-10 YOUR E-MAIL ADDRESS SITE ADDRESS ji K F_ THIS APPLICANT IS: O OWNER CONTRACTOR PROPERTY OWNER/ NAME:Diane-, 7W;�QrpArl-N (e U STATE ANW �9 S 2– TENANT ADDRESS: SQt4'Yl19 -1 CITY PHONE. Z ' 3 �� 2—If 56 CONTRACTORNAME: C arn:p otlllurntmu STATE LICENSE # �T 3p_ EXP DATE Rd. CITY STATE ziP SUBMIT A COPY OF YOUR STATE ADDRESS: 3670 Dodd LICENSE WITH PHONE Eagan, MN 55 APPLICATION PERMIT TYPE SINGLE FAMILY O TWO FAMILY O TOWNHOUSE TYPE OF WORK: O NEW OMPLACEMENT DETAILED DESCRIPTION OF WORK— Re pl ac 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 improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of r ) 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: (IIVDIC TE TOTAL NUMBER OF EACH BELOW) _ BATH SINK/LAV FLOOR DRAINS _ SHOWER _ WATER PIPING WATER SO —BATHTUB _ GAS PIPING MW =Lx ) _ SWIMMING POOL _ CLOTHES WASHER SINK WATER CLOSET _BACKFLOW PRE ($15. ($15) _KITCHEN DISHWASHER _ LAUNDRY TRAY _ WATER HEATER ($35) FOR IRRIGATIO OTS _ WATER METER _ PERMIT FEE PROJECTS FOR UNDER $500 PE avirr FEE FOR PROJECTS VER $500 Permit Fee $ 15 .0 Number of fixtures @ $1,0.00 x $10.00 = S e .50 Number of fixtures @ $15.00 x $15.00 = TOTAL DUE $ �.0 Number of fixtures @ $35.00 x $35.00 = State Surcharge = .50 Total = THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the woz i will be in is conformance with the ordinances and codes of the City of Fridley and with the Nnnesota Construction Codes; that I under and this the 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 acro with w and approval of p`laans./y� approved plan in the case of all worm w ' h re.F'_d5;E`L__--PR]NT A 9___r DATE C SIGNATURE OF APPLICANT , NAME VCO/1 t 1�S - Ay(� PLEASE NOTE: SEPARA " S UIRM FOR BUILDING ELECTRICAL AND CALV ORK City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 V A v. 17« CAP) nn 7r 7