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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N? 3166 Date: ... / .?� . S .................... =er.... ..9T'M!4yi... Bdder........... .............. .. .. .... ess. .... Address ............................................. LOCATION OF BUILDING No.�P.�� ... Street.-.. r �'i%.�' ti� ? .:...... Part Lot .. . ! �... Lot .... /.... lock ... f .............. Addition or Sub -Division .q.. .. ...... Corner Lot ............ Inside Lot ............ Setback .. Nr... Sideyard ....!.� DESCRIPTION OF BUILDING To 1p Used as: „p ........ Front g . yDepth . �.� . Height ..... ty Sq. Ft./. .�� Cu. Ft. ........ .................... Front ........ Depth ....... Height .o,b...I Sq. Ft. ........ jib. Ft. ........ Type of Construction ................... Est. Cost. a. V'4 !w....... To be Completed 1/.rn!.. .®...... . -4r01�7 s (�sG w In consideration of the issuance to me of a permit to construct the building desribed 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 city of Fridley. ..�........................................ In consideration of the payment of a fee of $..L...`, 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 city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. t c /+rx. ..!t /.!!` . Building Inspector NOTICE: �\ This permit does not cover the construction, Installation or alteration for wlring, umbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. r.� 4 w a f- City of Fridley, .Minn.. e BUILDING PERMIT Date: APRIL 14, 1966 CJ 0 Owner: Builder Address Address WARREN OSBORNE Xo 33�Q 3P 7565 University Avenue N. E. Fridley, Minnesota 55432 LOCATION OF BUILDING No. 555 Street 67th Avenue N. E. part of Lot Lot __ Block Addition or Sub -Division .� Corner Lot _— Inside Lot Setback — Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: STORM REBUILD Front — Depth Height — Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Cbnstructlon Frame Fit. Cost 19 000 _ To be Completed 877'1 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 liance with 21 provisions of ctrdinaaoes of the city of Fridley. In consideration of the payment of a fee of $J&M , permit is hereby granted to WARREN OSBORNE 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 ��gg location, construction, alteration, maintenance, repair and moving of buildings within he city limits ns permit may be revoked at any time upon violation of any of the provisions of said ALLEN G. JENSEN NOTICE: IhIs po mit does not emu the andrudtim, hugllation for wiring, plumbing, ges heathm ower or water. Be are to as the WMIng ingmftr for spm to permh for thea hems. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME �� •'Q� �Q�'° ���� BUILDER�M ADDRESS �,1/ Q ��e,//- 0- ADDRESS LOCATION OF BUILDING NO, STREET_ �� S� — � PART OF LOT LOT BLOCK ADDITION OR SUBDIVISION CORNER LOT__LINSIDE LOT SETBACK 1 SIDE -YARD SEWER ELEVATION FOUNDATION ELEVATION. Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING sed as; Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost % o `> 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 rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application' are true and correct. r DATE SIGNATURE (Schell a of F e Costs can be found on the Reverse Side). SUBJECT-- City of Fridley 5 1 AT THE TOP OF THE TWINS BUILDING PERMIT r � - RECO-' `v COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r 1 . � CITY HALL FRIDLEY 55432 ti.__.11.' '•� NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910415 10/20/97 JOB ADDRESS 555 67 Avenue NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 10 1 Rice Creek Terrace Plat 4 SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Bill Donelly 555 67 Avenue NE 571-1210 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Grundman Construction 5627 Lannon Ave, Albertville MN 55301 497-2235 4125 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 Cj REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof house & Garage (30 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REOUIRED 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 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1.25 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,502 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. $2.50 STRUCTION OR SHE PERFO ANCE OF CONSTRUCTION $74.75 PLAN CHECK FEE T TAL FEE /® s40 -f 7 LigenC $ 0 $83.50 5el IGN RE OF (fU&TRACTOR OR AUTHORIZED AGENT IDATEI HE PR Y VALI AT D THIS IS YOUR PERMIT r• �b f h BL INSP TATE S,GNATURE OF OWNERUF OWNER BUILDERI IDATEI NEW [ 1 ADDN [ J ALTER ( J ConstructionAddress : Legal Description: CITY OF FRIDLEY SINGLE FAIMILY,AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Effective 1/1/97 Owner Name & Address: _ Bi f/ Onne %ly SSS to iii Aui�f `UF Tel. #--S-7/ - / z ! O Contractor: A r j4,0 6&# A/ f MN LICENSE Address: �(p 27 La j4 iT.., ��rAlille Axy / Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Len Width Hgt/Ground Sq. Ft. OTHER:U �c� S SAC Charge $ $950 per SAC Unit Construction Type:.Tpa"f���,p , "�iU��11 �� Estimated Cost: $ � 2 $5.00 (State Licensed Residential Contractors) Driveway Escrow (Fee Schedule on Back) Driveway Curb Cut .Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 69-17 APPLICANT: Tel. # �'['iPULn'1'IO�ti1S: CITY USE ONLY Permit Fee $ r%� , S� Fee Schedule on Reverse Side Fire Surcharge $ - Q b .001 of Permit Valuation (1/10th%) State Surcharge $ /, 2S- $.50/$1,000 Valuation SAC Charge $ $950 per SAC Unit License Surcharge $ - Ol) $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 fewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ •. S� �'['iPULn'1'IO�ti1S: SUBJECt P IT NO. City of Fridley 31826 AT THE TOP OF THE TWINS BUILDING PERMIT REC COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 572-360 a /// NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910415 5/16/01 10B ADDRESS 555 67 Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 1 Rice. Creek Terrace Plat 4 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE William Donley 555 67 Avenue NE 763-571-1210 9 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK 0 NEW O ADDITION 0 ALTERATION j] REPAIR 0 MOVE O REMOVE 8 DESCRIBE WORK Reroof House & Garage (30 Sq) XNXKXM Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 1 HAVE READ AND EXAMINED THIS APPLICATION 1 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1.53 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $3,068 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE I T ;AL FEE 4101.85 Si NZURONTR 1 ATEA hjE PRO ED THIS IS YOUR/P/)F/RMIT %TR0R'V0OAGENT 01 A jjV/ALI �A/V - �r[ G7� ,�AWNERB l ERi A BLD-9INS� OA It NEW [ ] Effective 1/1/2001 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: 27-/4 Al /1 '4�e Legal Description: Owner Name & Address: Contractor: MN LICENSE # Address: 4':7Vt 64ot% r Tel. #�� LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Length Wdtt Height Sq. Ft. Hgt/Grounq _Sq. Ft. ' 'K l./ Construction Type: Estimated Cost: $ 304:��(s Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: Tel. #raja CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ , ��A Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ /.3 $.50/$1,000 Valuation SAC Charge $ $1150 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 $ D - CJS STIPULATIONS: CITY OF FRIDLEY PERMIT NO.: 2004-00146 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 02/03/2004 ►63) 572-3604 FAX: (763) 571-1287 ADDRESS : 555 67TH AVE NE PIN : 143024130028 LEGAL DESC : RICE CREEK TERRACE PLAT 4 : LOT 10 BLOCK 1 PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 1,500.00 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER SECTION 310.9.1.2 OF THE 1997 UNIFORM BUILDING CODE WHEN ADDITIONS, ALTERATIONS OR REPAIRS IN EXCESS OF $1,000 ARE MADE TO RESIDENTIAL DWELLINGS. COVER SOFFIT & FASCIA WITH ALUMINUM. IS APPLICANT A CONTRACTOR? I APPLICANT HOFFMAN-WEBER CONSTRUCTION LLP (203 18 66 WAY NE FRIDLEY, MN 55432- (763)670-9959 DONLEY WILLIAM G & KATHY L 555 67TH AVE NE FRIDLEY, MN 55432 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 thi;; type of wort will be complied with whether specified herein sir not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other stat or local law regula 'construction or the performance of construction. ApplicantN Date Bldg Insp BUILDING PERMIT FEE 54.00 FIRE SURCHARGE 1.50 STATE SURCHARGE, VALUE 0.75 LICENSE SURCHARGE 5.00 TOTAL 61.25 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. elot3 q ( cc NEW [ ] CITY OF FRIDLEY Effective 1/1/2004 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: JOV55- AVE- N C t-\ DC -f Legal Description: Owner Name & Address: 335 (&7 +-h p ve - Q L Tel. # Contractor: IAD rY-K - w t`s �c„,+S .� rod MN LICENSE # 5C - Z -o 3iL1 S$0 Address: ,,Pry Tel. # 76P3-&-2g-f(-(5-7 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 Type: P-ck-ovEz-\-v Estimated Cost: $ /,5oo Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: Z - I- yo'1 APPLICANT: -3o E Kc F --f Tel. # Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. C CITY USE ONLY - Permit Fee $®® Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1350 per SAC Unit License Surcharge $5.00 (State Licensed Residential Contractors) Curb Cut Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ STIPULATIONS: C CITY OF FRIDLEY PERMIT N .: 2004-00� 5 6431 UNIVERSITY AVENUE -NE FRIDLEY, MN 55432 DATE ISSUED: 05/21/2004 572-36U4 FAX: (763) 571-1287 ADDRESS 555 67TH AVE NE PIN 143024130028 LEGAL DESC RICE CREEK TERRACE PLAT 4 LOT 10 BLOCK 1 PERMIT TYPE BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DECK VALUATION : $ 3,713.00 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. CONSTRUCT A 23'X 13' DECK. REMOVE EXISTING DECK. APPLICANT DONLEY WILLIAM G & KATHY L 555 67TH AVE NE FRIDLEY, MN 55432 DONLEY WILLIAM G & KATHY L 555 67TH AVE NE FRIDLEY, MN 55432 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 worl 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 Annlit co ' qc the performance of const pb Annli .ant .Lil��•.a� i( Bldg BUILDING PERMIT FEE 97.25 PLAN CHECK FEE 63.21 FIRE SURCHARGE 3.71 STATE SURCHARGE, VALUE 1.86 TOTAL 166.03 PAID WITH CHECK # 6277 CPPAR ATF. PPRMTTC RPOT RTM FOR WORK hTNFR TRAY npgrRTRPn AROVF [] � CITY OF FRIDLEY f� Effective 4/1/2004 NEW NEW[ ] �. 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ADDNALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763)571-1 x BUILDING PERMIT APPLICATION r�0(4 Construction Address: -5 57 6 (° -770 A-Vt? t4 E Legal Description: Owner Name & Address: WO U/ &#R 4 KOCU4 D®c/i (e -q Tel. # Contractor. U) a4V MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft GARAGE AREA: Length Width Height Sq. Ft DECK AREA: Length Width 1.3 Hgt/Ground 1) Sq. Ft OTHER: P IMS 1 iL CK (Sft li q k cl--, Construction Type: ' 4 &AAY' Estimated Cost: $ Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ —=$ DATE: '571teri0 APPLICANT: Xd622Tel. # 76 -5--E-11 -J ?, %® Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 ff using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 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 [ TOTAL $ 1 STIPULATIONS: P , zo 76 • 10 CEDAR NOTCH F AND BOL THROUGF AND PO; m GERS ON ICHORED TO ACKET, WITH 10 2X4 CEDAR .INGS 2X10 LEDGER BOARD IS LAG BOLTED TO HOUSE. dRIP CAP ABOVE IT AND CAULKING FOR WEATHER TITE SEAL TO STUCCO. GALV, JOIST HANGERS FOR 2 X 10 NAILED TO LEDGER AND JOISTS WITH 10 d NAILS j� � a w 4tMF—jpf kve4 ptq4 kAk-Aq ep e 6pp �CQ .b 1 X VOID IS FILLED IN WITH j X 6 rrrnwo 2-2X10 WITH J❑IST HAt BOTH SIDES. BEAM IS A FO❑TING WITH GALV. BF NAIL BEAM T❑ BRACKET d'S 2X4 CEDAR "T'_INGS ixe WITH BLOCKING FPR ANGLE BEANS BOLTED POSTS Myi. W5F 11 DECK IIII II'llllllllll I�IIII II II.I II IIIIff PPJ m MM— noI� 66XX 6 CEDAR POST ON V ANCHOR I AND I-INAL n+�rt� i i�ra5 ! FOOT WITH i I —dam c►� �E� � � 12 m�E R� I �4 n! •DEKORATEW BALLUSTERS WITH PRE-DRD.LED CEDAR RAD_INGS --% "ll 3' 15' X 50 DEEP CONC. FOOTINGS 4 GALV, HANGERS ON BOTHSIDES ` OF 2-2X10 BEAM IAQ �--- Nfl NI©I� g Q m illmimimi Cpl 2 4 A 4 HANDRAILING Pnerc MAX r4 �,Dm calcs Gst,-' zoic -1c ., TSE vo'IVg,,F-p ,p,v-> / 11114 Wl L4- KES j o.3 ntia �a t_C✓r_t_ cQ L4hv, bc- 4 i 1 � I 1� MAX r4 �,Dm calcs Gst,-' zoic -1c ., TSE vo'IVg,,F-p ,p,v-> / 11114 Wl L4- KES j o.3 ntia �a t_C✓r_t_ cQ L4hv, bc- 4 CITY OF FRIDLEY INSPECTION DIVISION �5- / 1 6431 University Ave NE Effective On January 1, 2 Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE JOB ADDRESS SYS—i(% � e4-< N Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Rate $ 30.00 $ 10.00 $ 10.00 $ 10.00 $ 25.00 State Surcharge TOTA� FEE MINIMUM OWNER 4 >/ / TOTAL BUILDING USED AS RESIDENT AL ESTIMATED COST _ C*J0 PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $ Trade Name Size No. BTU HP EDR $ Fuel --Total Connected Load FIREPLACES --- Burner Trade Name IjeaT -Af-6/a Size No. j4WI ✓ $ BTU HP EDR $ The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes an $ .50 rulings of the Building Division, and hereby declares that all the facts and $ 6— representations stated in this application are true and correct. �S -- DATE FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERMTIONIAIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side written permission from adjoining property o� HEATING CO ALLIED FIRESIDE dba FIRESIDE CORNER ppa 10 D 27IZ I without Approved By Rough. TEL # 6-1 - 031 -/®�X.2_ Final Date Iw 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 ( ) A13pliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS:(Describe) HEATING CO: Signed By: Date Building $ BUILDING Permit No.: Inspections 65% of Building Permit Fee RESIDENTIAL APPLICATION Received By: 763-572-3604 Fire Surcharge CITY OF FRIDLEY Date Rec'd: DATE d L YOUR E-MAIL ADDRESS Tib I�Li ] Irl��✓LS['�, ` it I )OK-�9 N SITE ADDRESS(` W AV I -J L $1450 per SAC Unit (Plans to MWCC for determination) THIS APPLICANT IS: ❑ OWNER CONTRACTOR ft + 6 ft = ft x $20 = $ PROPERTY OWNER/ NAME: I L I, a #-J L— $450 Conservation Plan Review TENANT ADDRESS: $ - d -J C, CITY r -Zia ic�f STATEh1IZ-IP Z Sewer Main Charge PHONE: ^/(B 3 , r; 71 Agreement necessary ( ) Non Necessary ( ) CONTRACTOR NAME: 1199V11 l� Make checks payable to: City of Fridley Attach Stipulations STATE LICENSE # 2 03 19 91, !' 0 EXP DATE---' 62 SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: 0 7 O -734 L3j P f- 1/ CITY `i r STATErV4IP 5.S0 WITH APPLICATION PHONE .- (OZ- 3(p(v FAX,Q '/4 v PROPERTY TYPE XSINGLE FAMILY/NEW CONSTRUC ON SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING OTHER 11SWlM%4I1G PIMP TYPE OF WORK: ❑ NEW ❑ ADDITIO 1>9Z4A1NTENANCE/REPA1R ❑ REMOD DESCRIBE WORK BEING DONE: 620 SIZE OF IMPROVEMENT LENGTH WIDTH g HEIGHT Sq. Ft. ROOFING�KIiOUSE ONLY NUMBER OF SQUARES'? ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl []Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other Fascia and proposed project WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes [No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ _ 1,gDD OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Surcharge $ (.0005) times the total job valuation — Minimum $.50 Fire Surcharge $ .001 x Permit Valuation (1/10%) License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1450 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $20 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ Make checks payable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work.which requires r view an approval of plans. 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II II II II II II II it R, PONM aur PEFA,;el t)/l Pu1tDrp5 WILLlN7 DONI-tY ,POOF n5'S 6-ffn AEV N.E. 4MN 9910 234 T -H LANE NE. STAGY, MINNESOTA LammFPVI-FY, MINNESOTA L NAmmmY r. 1 Lic. #20385348 6V-462-3669