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PRE 2010 DOCSBUILDING PERMIT Village of Fridley, Minn. N? 242 Date//= --/-V Sf..7........................ Builder ..................... Address Address ......................................... LOCATION OF BUILDING No. . %f.Zs ....... Street .47a. - -......... __P --art of Lot ....--.�.................. . Lot ....... q ....... Block ... / ........... Addition or Sub -Division l..�,lr .lyJ ..�..... . i Corner Lot .... %!'� ... Inside Lot ......... Setback Sideyard ../Y"O DESCRIPTION OF BUILDING To be Used as: b016"-* . .... Front qe4 ... Depth ato ... height `�$4 ... Sq. Ft.1®; . Cu. Ft........ . Front ........ Depth `........ Height ......... Sq. Ft......... Cu. Ft.......... . Type of Construction 11 .. Est. Cdit 14.(9.®®� ......... 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. In consideration of the payment of a fee of $/ff� :.. , permit is hereby granted to 497,.. . ......... //-akr .o ........... 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. 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 separate permits for these Items. 0 City of Fridley, Minn. BUR DING PERMIT N® 3846 Date: ....'6--47� ......�.. ........... Owner .. ���t'<'s.�'r!?�......... .... Builder ......... ...................................... Address ...................................... Address ............................................. i� TI OF BUILDING No. . 10� Street .......... Part of Lot ........................ , Lot ... /....... Block ............. o or Sub -Division .. .. Corner Lot ............ Inside Lot ............ Setback ............ Sideyard ........................... DESCRIPTION OF BUILDING Am4i-A— � Front �'{� Depth �`?.. J. Height Sq. Ft. 13S Cu. Ft.4�j. G .................... Front ......... •Depth ........ Hei ht ........ Sq. Ft......... Cu. Ft........ . 0 Type of Construction ................ Est. Cost...,�0.. . 5.. � .. To be Completed .................. . 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 $..., 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. J 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 sepaede permits for these Items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owners - Name. r jiv% iJ10 V4Aj j j Builder Address`- (�.���h!� ;:� Address _ LOCATION OF BUILDING No..� Street _ Part of Lot Lot _.,_. Bloch Addition or Sub. Div. Co•Lot­ Inside Lot Set Back Igr licafit attach to this form Certificate of Survey of Lot and proposed binding- location. To-` ­be iised as DESCRIPTION OF BUILDING Front. Depth J+/ Height Sq. Ft. Cu. Ft. Front ._Depth eight Type'of'Constructi,on Estimated Cost To be completed The"undersigned_-hereby makes application for a -permit for the work heibin 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., Date Signature (A Schedule of Fee Costs can be found on the Reverse .Side) C • Date: — 9/1/67 Owner: Address City, of Fridley, Minn. BUILDING PERMIT Merril Jordahl 575 67th Ave. N. E. No. 575 Street Lot ---- -_ Block Builder Same Address Same — LOCATION OF BUILDING 67th Ave. N. E. _ — part of Lot Corner Lot ._ Inside Lot Sewer Elevation Addition or Sub -Division — Setback _ __ Sideyard Foundation Elevation DESCRIPTION OF BUILDING 391 N® 9431 To be Used as: Repair Base.llr Crawl Space— F=t 40 Depth Height — Sq. Ft. Cu. Ft. +Addn . Front Depth Height . — Sq. Ft. Cu. Ft. Type of Construction Cement Block Fst. Cost _ $500.00 _TobeCompleted In consideration of the issuance to me of a permit to construct the building the proposed work in accordance with the description above set forth and in -co co ordinances of the city of Fridley. ---,rx 77 , I agree to do 90m►laions of In consideration of the payment of a fee of s --L- 0_0 , permit is hereby granted to Merril Jordal 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 anypart thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of d ordinances. CLARENCE BELISLE _BuildWgLnpwW NOTICE: This permit does not cover the construction, installation for whing, plumbing, gas heating, ower or water. Be are to sa the Bulming hnpastor for aperate peneHs for thea Nems. L1C.%_1.r1a FOR 3I_i,DI1,G CITY OF M%7Mr-i•, NDN ;ESC;TA OWNER'S NAME ADDRESS 4:� % �c�_ ��ADDRESS LOCATION OF BUILDING VO. STREET LOT BLOCK ADDIT10N OR SUBDIVISION CORNER LOT INSIDE LOT SETBACK PART OF LOT 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 To Be sed Ad: _ ; ^ Front Depth / Height Sq. Ft. Cu. Ft. Front _Depth 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 rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE SIGNATURE'41 L -. (Schedule of Fee Costs can be found on the Reve a Side). City of Fridley, Minn.. N9 9503 BUILDING PERMIT 0 Date: — Oct. 16, 1967 • 0 Owner: Merriel H. Jordahl Builder — Carlson & Son 6onst. Address 9228 Terrace Road Address 4416 3xA ve N- E _ No. 5 75 Street Lot — 8 __ Block LOCATION OF BUILDING 67th Ave. —_ part of Lot 1 — Addition or Sub -Division . __ _ Rice Creek Terrace Corner Lot _ X.� Inside Lot Sewer Elevation �— Setback --- Sideyard Foundation Elevation DESCRIPTION OF BUILDING To be Used as: (Foundation Existingg]j Dwelling Front _ 64' Depth37'� Height —12-L Sq. Ft 1420.5 cu, 17 _046 Garage — Front Depth _ _ Height . _ Sq. Ft. . _ Cu. Ft. Type of Construction __ Frame _Est, Cost ­ $23y000 To be Completed �1 May 1, 1968 In consideration of the issuance to me of a permit to construct the building descri above, I agree to do the proposed work in accordance with the description above set forth and compi th r°�� of ordinances of the city of Fridley. ,, � A, � /� /., � 4/� In consideration of the payment of a fee of $ 31.00 , permit is hereby granted to _ WXYRZXXIM Merril Jordahl 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 Vthe dty limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. CLARENCE BELISLE Building Inspector NOTICE: 'fids permit does not cover the construction, installation for wiring, plumbing, gas heating, sower or water. Be sire to ao the Building Inspector for separate permits for thea home. APPLICAT: N FOR BCTILD111G PERMIT CITY OF FRIDLEY, MINNESOTA OWNER ° S NAME ley6LALLV Q, h — BUILDER 4cS6N ADDRESS� �? LOI DP.E s s40,E--0uk.k .� LA,� ' LOCATION OF BUILDING No . ,5/ &- STREE T� U� .l�V PART OF LOT LOQ --p - -- - BLOCK ADDITION OR SUBDIVISION C^ CORNER LOxITiSDE LOT �SETBACK _SIDE-YA SEWED BLEVATICON ; ; FOOiEDAT'ION ELEVATION 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 Ad:41 Front //. (D Depth � � height ..� 0 silo /,ON Sq. Ft. ! � �� Cu. Ft. 70 Front O � Depth „ p �Z Y f10 "'Height CD Sq. Ft.� Jr�D Cu. Type Construct of ion►. - 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 rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE / o �� SIGNA.I'UR-P (Schedule of Fee Costs can be found on the Reverse Side). ro• City of Fridley Application for Plumbing and Gas Ming Permit Dept. of Bldgs. Phone 560-3450 z DESCRIPTION OF WORE7v� Number. Kind and Location of Fixtures Locaiiort lrJ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ........... .......... x $2.00 $ Future Fixture Opening ................ x $1.50 $ New Fixture Old Opening .............. Catch Basin ... .. .................... Water Heater (Up to 99,000 BTU) ...... New Ground Run Old Bldg. ............ Electric Water Heater GAS FITTING FEES: NO. 1st 3 Fixtures .......................... Additional Fixtures .................... Gas Range to 199,000 BTU .............. REPAIRS & ALTERATIONS—Refer to Code X $1.50 $ x $3.25 S� X Z_ �� �� S `aJ �� 0 t�0 a $2.00 $ WATER HTR. GAS ELEC. Base $ O'er, x $ .75 $ x $5.00 $ 1st - 2nd 3rd 4th • Future Connection Openings * New Fixture, Old Openings I Connected with Sewer Cesspool 0 PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ........... .......... x $2.00 $ Future Fixture Opening ................ x $1.50 $ New Fixture Old Opening .............. Catch Basin ... .. .................... Water Heater (Up to 99,000 BTU) ...... New Ground Run Old Bldg. ............ Electric Water Heater GAS FITTING FEES: NO. 1st 3 Fixtures .......................... Additional Fixtures .................... Gas Range to 199,000 BTU .............. REPAIRS & ALTERATIONS—Refer to Code X $1.50 $ x $3.25 x $3.00 $ x $3.25 $ a $2.00 $ RATE TOTAL x $2.00 $ O'er, x $ .75 $ x $5.00 $ City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. Fridley, Minn /6 -% 19 G Owner Kind of Building 4 �� Used as To be completed about Estimated Cost, Old—New. Building Permit No z Permit No.�� Signe By Business Phone No ROUGH FINAL Description ...............................................$7�'6 TOTAL FEE $ Application for Power Plants and Healing, Cooling, Ventilation, Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ...........................$10.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 .................. 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ each add. 60,000 BTU ....................... 3.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 .............. 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... $10.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $ Each add. 200 sq. ft. EDR Steam ...................... 3.00 $ Each add. 320 sq. ft. EDR Hot Water .................. 3.00 $ OIL BURNER—to 3 gal. per hour ........................ 6.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 199,000 BTU) ....................... 5.00 $ over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x$ 2.00 $ Additional Fixtures ................. x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ AIR CO1QDMONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $� ALTERATIONS & REPAIRS TOTAL FEE $ ROUGH FINAL Dept. of Bldge. Phone 560-3450 ,- 7� -- City of Fridley: T 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. Owner Fridley, Minn. / r 19� 2 Kind of Building�'� Used as To be completed about 0 Estimated Cost, $ Old—New. Building Permit No. Permit No. '5 DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot W�ateerr, Warm Air—No Trade Name ,�aPis� / Ci' y>�%��/G�/ Size No_ Capacity Sq. Ft. E.D.R BTU A.P. Total Connected Load Kind of Fuer BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS -OVER) X/ Signe By 1-1 COIDD42 Business Phone No city of Fridley AT THE TOP OF THE TWINS SUBJECT_­PERMIT._NO. BUILDING - P E R M 27555 � COMMUNITY DEVELOPMENT DIV. r w PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 612-571-3450 �" R_ECEIP_T NQ.-"-' 5746 NUMBER 910 -FIS REV DATE 94-1498 PAGE Of APPROVED BY JOB ADDRESS 575 67th Avenue NE 1 LEGAL DESCR. LOT NO. 8 BLOCK 1 TRACT OR ADDITION Rice Creek Terrace Plat 4 SEE ATTACHED SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jordahl 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Scott Construction 5545 Knoll Dr Shoreview MN 55126 - 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage 30 SO Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 80 DAYS, OR IF CONSTRUCTION ZONING SO. 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 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED VALUATION SURTAX WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 2571 $1.29 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. 74.75 Fir SC 2.57 a PLAN CHECK FEE TOTA FEE Licen S 5 00 8 .61 51 NATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI OPE A DA TNI$ I$ Q P IT.iWSIGNATURE 4EN INlP MATE OF OWNER of OWNER BUILDERI IDATEI i NEW [ ]" Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION 16 ConstructionAddress: `_7`7T��. �^ t� �. Legal Description: Owner Name & Address: Jot dc-, k t Tel. # Contractor: o_/ e'_,A C�k `) MN LICENSE # 10,u 2-oi31$ 22- Address: j /Ytio it - S4111 1/1 S j Z G 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 Hgt/Ground Sq. Ft. OTHER: Construction Type: -� �2C� �/, Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: y 3 - G/ Y APPLICANT: Tel. # Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: ,S-. (1 o CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.501$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 [ ] CITYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 . (612) 571-3450 • FAX (612) 571-1287 July 1', 1992 Joan Jordahl 575 - 67th Avenue N.E. Fridley, MN 55432 RE: First Notice of Noncompliance at 575 - 67th Avenue N.E. Dear Ms. Jordahl: The City of Fridley has established a City Code for the purpose of promoting a pleasant and attractive suburban environment. A recent inspection of the property at 575 - 67th Avenue revealed that not all Code requirements are presently being met. Listed below are items which do not comply with the City Code: 1. Discontinue outside storage of cement blocks, brush, and assorted materials located at the northwest corner of the property. Your prompt attention in correcting this situation would greatly assist us in helping make Fridley a better place to live. An inspection will be conducted on or about July 20, 1992, to determine compliance. If you have questions or would like to discuss this, please contact me at 572-3595. Thank you for your cooperation! Sincerely, Steven Barg Code Enforcement Officer SB:ls CE -92-308 CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Effective On January 1, 2001 Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 763-572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS ;?-:);?-:)-7 - 6 / Ut�� C RATE SCHEDULE 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 TOTAL $ 30.00 $ W-00 $ 10.00 $ fO�6'U $ 10.00 $ $ 10.00 $ $ 25.00 $ d`�.5' Ou State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. $ OWNER �� -P--. OWNER BUILDING USED AS ESTIMATED COST PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air Trade Name 60� Size No. BTU 8 tad6 HP EDR % Fuel A44- GA -S Total Connected Load Burner Trade Nam L1.11111 Size N 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 representations stated in this application are true and correct. DATE 49 Ir 4 �02 HEATING CO AG Signed TEL # 7613 - 7e7 - Approved By Rough -In Date Final Date BACK SIDE MUST BE FILLED IN ON VENT SIZE, VENT CONNECTORS AND COMBUSTION AIR VERIFICATION 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 (eNo ( ) The venting system is plastic[PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes (/o ( ) 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 (V'No The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes allo( When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes (O/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 (P(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 (iehlo ( ) 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) y --91e) )(Z4Ae� We/ -W- — i x7— HEATING CO: Signed By:&W&5�4Date : �' 11 NEW [ ] CITY OF FRIDLEY 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: �7 J & -a E Legal Description: Owner Name & Aa Contractor. Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: d ess: '!ioa,A o{ —Tel.# -7&3-S71`(off2 MN LICENSE # Tel. # A 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 Width ) mesial( a baste _ Height Sq. Ft _ Hgt/Ground Sq. Ft VL&z ( " 'e'ws. Construction Type: W-009 Fv &.-g Estimated Cost: $ 4 70D, 00 OP61)IA-a Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ —=$ DATE: L 30 ,�-- APPLICANT: 015(9`!1 1'4440 Tel. # -70-&�HPNI 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. 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 $1450 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 $ JU - W STIPULATIONS: --o 7' AA iz �c� �t19lWt V�X1� iZb-xy\k byvAsvM �(SY K Building $44 % . 90 BUILDING Permit No.., d Inspections 65% of Building Permit Fee RESIDENTIAL APPLICATION Received By: 763-572-3604 Surcharge CITY OF FRIDLEY Date Rec'd: 763-502-4977 FAX $ $5.00 (State Licensed Residential Contractors) SAC Charge $ EFFECTIVE 1-1-08 Curb Cut Escrow DATE � V. w / )'00% _ YOUR E-MAIL ADDRESS �CV t M � �Ma,�I o Ct<1►M SITE ADDRESS T1 VT"Ayk THIS APPLICANT IS: OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: ` �1�^� _ ADDRESS: ��`� 1— !� e CITY P6 AW STATE.g_ZIP�y-2A TENANT Sewer Main Charge PHONE: 3J - 519 � ` VRa 1 l� " 1►70 = �3� ee�� Sar► �C { orwNr,� w;'k Agreement necessary ( ) Non Necessary ( ) NAME: ADDRESS: CITY STATE ZIP CONTRACTOR SUBMIT A COPY OF PHONE FAX YOUR STATE LICENSE STATE LICENSE # EXP DATE PROPERTY TYPE It SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES°t PERMIT TYPE❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCIE/REPAIR L REMODELING ul13 r►511�d rs r Ws 1 Q; �'I IodS¢uytl/h�' Ww'�BuaS DESCRIBE WORK BEING DON�&a* SIZE OF IMPROVEMENT LENGTH aQ.I WIDTH l a t HEIGHT �� `� r, SQ FT ago ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE I. 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 ❑ Vinyl ❑Soffit ADDITIONS, & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS3. Energy Calculations IN EXISTING OPENINGS MJJYes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED �SIdSS blot` 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 $ 1o2 q . ®0 OCCUPANCY TYPE Permit Fee $44 % . 90 See Back Wage for Fee Schedule Plan Review $ N 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ 42 .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 $ 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 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 on site; that the work will be in acco ance with t pproved plan in he case of all work which requires review and approval of plans. SIGNATURE OF APPLICANT PRINT NAME � nmx J ©r ►a l9DATE7-J-y.6g APPROVED BY - DATE CIIYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 BUILDING PERMIT APPLICANT: PROPERTY OWNER understand that the State of Minnesota requires that all residential building contractors, remodelers and roofers obtain a state license unless they qualify for a specific exemption from the licensing requirements. As the owner of the property at S 7s� (P91S Arty mc , Fridley, I am exempt from the state licensing requirement only if I am not building or improving this property for purposes of resale. By signing this document, I attest to the fact that I am improving this house for my own use and do not intend to sell it. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building or remodeling on speculation or for resale and that the house for which I am applying for this permit, isl the first residential structure I have built or improved in the past 24 months. I also acknowledge that because I do not have a state license, I forfeit any mechanic's lien rights to which I may otherwise have been entitled under Minn. Stat. 514.01. Furthermore, I acknowledge that I may be hiring independent contractors to perform certain aspects of the construction or improvement of this house and I understand that some of these contractors may be required to be licensed by the State of Minnesota. I understand that unlicensed residential contracting, remodeling, and/or roofing activity is a misdemeanor under Minnesota law, and that I would forfeit my rights to reimbursement from the Contractor's Recovery Fund in the event that any contractors I hire are unlicensed. I have also been informed and acknowledge that by listing myself as the contractor for this project, I alone will be responsible to the City of Fridley for compliance with all applicable building codes and city ordinances in connection with the work being performed on this property. Name Date THIS JOB COPY SHALL 8E AVAILABLE ON THE JOB &ins%vj(SITE FOR THE FRAMING AND FINAL INSPEC-410I4S REVIEWED FOR CODE l f �FLIA gL �I she Oil ��*g t 3at, 1 M46 'h(4'(®K Po,;,,A ('V("O o*►cw-:nc� blxi°oJ15 a 6106 block.,u;lt%w g 44 A116 - 6 11+b ks bla t iNuft6 '1® WOC Rb+.+o"s t ai bac As 11bclwl Coe milks fig• )brliwtll A -K cle t1 v s -)c fb��1�s� cep "`c15 6,kt04 ok 1c ISMVA c;a r,,ar,� w dau.) wstl djodIP^ .4 Of alv%.' TE PERM%TS!5ns 6-&,4ve vuo--�- - - T" Ao zit J' rniv\ ck ` � teRnl'k) 91 MU c 01 4 T Building $ 4-7o cio BUILDING Plan Review Permit No.: - Inspections Fire Surcharge RESIDENTIAL APPLICATION .001 times the total job valuation Received By: 763-572-3604 .0005 x Permit Valuation Minimum $-50 CITY OF FRIDLEY $ Date Rec'd: - v 763-502-4977 FAX EFFECTIVE 1-1-08 $1825 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow ®� DATE-!UC YOUR E-MAIL ADDRESS h -v 1 gpy) C C L'w►Ct� b`f, n �' SITE ADDRESS J AX4k Chi $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering THIS APPLICANT -IS'. WowNER ❑CONTRACTOR Agreement necessary ( ) Non Necessary ( ) PROPERTY OWNER/ NAME: O Make checks payable to: Ci of Fridley Attach Stipulations TENANTADDRESS: (C°� t L CITY STATELVIN �eS�I3of PHONE: -% 1Y —ID f 4W Ctl Jaws NAME: %1o3 —&70'V 9 ADDRESS: CITY STATE ZIP CONTRACTOR SUBMIT A COPY OF PHONE FAX YOUR STATE LICENSE STATE LICENSE # EXP DATE PROPERTY TYPE WSINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK:❑NEW HOME CONSTRUCTION ❑ADDITION VMAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT GTH WIDTH ) HEIGHT 611 sQ FT 146,s 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 1. 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 TOT ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 UBC FEE SCHEDULE) JOB VALUATION $ 12M OCCUPANCY TYPE Permit Fee $ 4-7o cio See Back Page for Fee Schedule Plan Review $ 3 t , \_U 65% of Building Permit Fee Fire Surcharge $ i �':A .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 $ Q ..Cl d _ Make checks payable to: Ci 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 odes; that I 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 o�%Mfllbe in acro with the ov an in e c of all work which requires review and approval of plans. SIGNATURE OF AA1JT G�IGt (_ t, PRINT NAME -.J 6 a i,., L , t+t ��t L DATE I FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 BUILDING PERMIT APPLICANT: PROPERTY OWNER 1, - (Ad)n\ understand that the State of Minnesota requires that all residential building contractors, remodelers and roofers obtain a state license unless they qualify for a specific exe ption from the licensing requirements. As the owner of the property at -S,7-s- (tr w ISI , Fridley, am exempt from the state licensing requirement only if I am not building or improving this property for purposes of resale. By signing this document, I attest to the fact that I am improving this house for my own use and do not intend to sell it. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building or remodeling on speculation or for resale and that the house for which I am applying for this permit, isl the first residential structure I have built or improved in the past 24 months. I also acknowledge that because I do not have a state license, I forfeit any mechanic's lien rights to which I may otherwise have been entitled under Minn. Stat. 514.01. Furthermore, I acknowledge that I may be hiring independent contractors to perform certain aspects of the construction or improvement of this house and I understand that some of these contractors may be required to be licensed by the State of Minnesota. I understand that unlicensed residential contracting, remodeling, and/or roofing activity is a misdemeanor under Minnesota law, and that I would forfeit my rights to reimbursement from the Contractor's Recovery Fund in the event that any contractors I hire are unlicensed. I have also been informed and acknowledge that by listing myself as the contractor for this project, I alone will be responsible to the City of Fridley for compliance with all applicable building codes and city ordinances in connection with the work being performed on this property. Name .. �., 71 t Date__ It - 7- 0 s Building $ q17 "Q'6- BUILDING Plan Review Permit No.: a6 Inspections Fire Surcharge RESIDENTIAL APPLICATION .001 times the total job valuation Received By: 763-572-3604 .0005 x Permit Valuation Minimum $.50 CITY OF FRIDLEY $ Date Rec'd: -a3—fU 763-5A^02-4977 FAX $ $1825 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21 = $ EFFECTIVE 1-1-08 $ $450 Conservation Plan Review DATEtl l a a� a010 YOUR E-MAIL ADDRESS6_V 11M P_ 9Wid�i� , t0A4 Fee Determined by Engineering SITE ADDRESS ,S i 15 $ THIS APPLICANT 1S: 9OWNER ❑CONTRACTOR Total Due PROPERTY OWNER/ NAME: JORA Y� 1 �^- W TENANT ADDRESS: 5 tJ G AU -4 Ill it CITY r( STATE ZIP PHONE: 7co3' S°7I —� K9 eon J+c��11�s/upda�es at 7b3 -(a7�-7'93 NAME: ADDRESS: CITY STATE ZIP CONTRACTOR SUBMIT A COPY OF PHONE FAX YOUR STATE LICENSE STATE LICENSE # EXP DATE PROPERTY TYPE WSINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILYMEW CONSTRUCTION STORIES PERMIT TYPE 13 ADDITION ❑ GARAGE/SHED ❑ WINDOWS 09 BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ADDITION ❑ MAINTENANCE/REPAIR REMODELING DESCRIBE WORK BEING DONE: a xy �ra m;n� (w,416 4 Se tS� f$CE5SP_A i Ahth W 0- tS, d.0of5 , 9NWbl1 cei� wa115 an& 1,15t►It 41eorlr�d . SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ 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 1. Site Plan/Survey showing the existing structures ❑ Aluminum ❑ Trim and proposed project. 13 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 $ 30U 00 • 00 OCCUPANCY TYPE Permit Fee $ q17 "Q'6- See Back Page for Fee Schedule Plan Review $ 03011 65% of Building Permit Fee Fire Surcharge $ 30'7 .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 $ Q ej, 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 on site; that the work will be in a dance with e a oved plan in the case of all work which requires review and approval of plans. SIGNATURE OF APPLICANT c fi PRINT NAME lafl c I c� Ir a / DATE q APPROVED BY -�— DATE FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287 BUILDING PERMIT APPLICANT: PROPERTY OWNER I, Jcah �\ oc 1a1 \ understand that the State of Minnesota requires that all residential building contractors, remodelers and roofers obtain a state license unless they qualify for a specific exemption from the licensing requirements. As the owner of the property at 199 (o'-}}vq ki k , Fridley, I am exempt from the state licensing requirement only if I am not building or improving this property for purposes of resale. By signing this document, I attest to the fact that I am improving this house for my own use and do not intend to sell it. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building or remodeling on speculation or for resale and that the house for which I am applying for this permit, isl the first residential structure I have built or improved in the past 24 months. I also acknowledge that because I do not have a state license, I forfeit any mechanic's lien rights to which I may otherwise have been entitled under Minn. Stat. 514.01. Furthermore, I acknowledge that I may be hiring independent contractors to perform certain aspects of the construction or improvement of this house and I understand that some of these contractors may be required to be licensed by the State of Minnesota. I understand that unlicensed residential contracting, remodeling, and/or roofing activity is a misdemeanor under Minnesota law, and that I would forfeit my rights to reimbursement from the Contractor's Recovery Fund in the event that any contractors I hire are unlicensed. I have also been informed and acknowledge that by listing myself as the contractor for this project, I alone will be responsible to the City of Fridley for compliance with all applicable building codes and city ordinances in connection with the work being performed on this property. Cgrtsi, W,Adew Ne v0 -um Crl;w I,oe&W�6 Ce miiW C?jx►xi�,Waovi-oiR4`1� L I 0 - i s� 0 J VA C, 4 9ILI S • dgd,n.S$ ichv lot black) 1�-i jwj1ot bots b4'"M_ X A 0 • .-b -dzCtJ s jq s , 0 - i s� 0 J VA C, 4 9ILI S • dgd,n.S$ ichv lot black) 1�-i jwj1ot bots b4'"M_ X Building PLUMBING Permit No.: atl 10WO Inspections RESIDENTIAL APPLICATION Received By 763-572-3604 CITY OF FRIDLEY DaWAY 1 763-502-4977 FAX EFFECTIVE 1-1-2010 DATE t5JI1110 iYOUR E-MAIL ADDRESS a W I� 61, UI l SITE ADDREss ! 1091mAve, NL - THIS APPLICANT IS: DOWNER ❑CONTRACTOR PROPERTY NAME: OWNER/ p ADDRESS: 5757 /fir Ayt rJ)ff C TY ry- Al" STATEPULZIP'Z TENANT PHONE: CONTRACTOR NAME: 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 SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: NEW ❑ REPLACEMENT DETAILED DESCRIPTION OF WORK ` i S °�' '4 o epi d FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $35.50. 1� BATH SINK/LAV DRAINS SHOWER WATER PIPING _FLOOR _ BATHTUB GAS PIPING (NEED CITY LIC) SWIMMING POOL WATER SOFTNER ($35) _ _ CLOTHES WASHER SINK WATER CLOSET _ BACKFLOW PREV. ($15) —KITCHEN —DISHWASHER _ LAUNDRY TRAY HEATER ($35) FOR IRRIGATION _WATER WATER METER OTHER ,Fj }r Rlx" 31 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 p it and work is not to start without a permit on site; that the work will be in accordance with the approved plan in ase o 1 r whl re uires review and appro al of plan S SIGNATURE OF APPLICA PRINT NAME 0044 . 6j4gtL4ATE 5-A-10 City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 BUILDING PERMIT APPLICANT: PROPERTY OWNER 1, jOo-4& L -� o (.-16 L ( . understand that the State of Minnecnta renrnirec that all residential building contractors, remodelers and roofers obtain a state license unless they qualify for a specific exemption from the licensing requirements. This license requirement applies to owners of residential real estate who build or improve such property for purposes of speculation or resale. By signing this document, I attest to the fact that I am improving this house for my own use and am not building or improving this house for the purpose of reselling it. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building or remodeling on speculation or for resale and that the house for which I am applying for this permit, located at S 7 S (n``�'`' A44 1 & TA , is the only residential structure I have built or improved in the past 24 months.'l also acknowledge that because I do not have a state license, I forfeit any mechanic's lien rights to which I may otherwise have been entitled under Minn. Stat. §514.01. Furthermore, I acknowledge that I may be hiring independent contractors to perform certain aspects of the construction or improvement of this house and I understand that some of these contractors may be required to be licensed by the State of Minnesota. I understand that unlicensed residential contracting, remodeling, and/or roofing activity is a misdemeanor under Minn. Stat. §326B.082, subd. 16 and can also result in a fine of up to $10,000. I further state that I understand that the filing of a false statement with The City of Fridley may also result in criminal prosecution and/or civil penalties to applicable city ordinances and/or state statutes. I have also been informed and acknowledge that by listing myself as the contractor for this project, I alone will be responsible to The City of Fridley for compliance will all applicable building codes and city ordins wit�ejork being preformed on this property /7 n (, -=2 Date For questions or information on contractor licensing, or to check the licensing status and enforcement history of a particular contractor, call the Minnesota Department of Labor and Industry, Construction Codes and Licensing Division, at (651) 284-5069. The web site is: http://www.dli.mn.eov/Ccid.asp 5-75 G -0 fWAt *vvA CT�V\SpeCOVA04) ie. VA4'Waov8 -01.141) I G• � � lI s x I f E IM N r C" ak lip )�;b�ik� bans 62}•aeP,v� �' Building MECHANICAL Permit No.: a' InspectionsRESIDENTIAL APPLICATION Received By: 763-572-3604 eddt=!N O 2010 CITY OF FRIDLEY 763-502-4977 FAX EFFECTIVE 1-1-2010 DATE -131110 YOUR E-MAIL ADDRESS SnE ADDRE$$ 65 (07ye / J )F THIS APPLICANT IS: OWNER OCONTRACTOR PROPERTY NAME: I _ p� S75- b9'4 -p yP, A t CITY lA 1 STATi MAr.ZIP 5543d OWNER/ TENANT ADDRESS: 20-S71-6911 PHONE: CONTRACTOR COMPANY NAME: CONTACT PERSON: SUBNET A COPY OF YOUR STATE STATE LICENSE # EXP DATE LICENSE WITH ADDRESS: CITY STATE ZIP APPLICATION PHONE FAX CKSINGLE FAMILY O TWO FAMILY O TOWNHOUSE PERMIT TYPE NEW O REPLACEMENT ® ALTERATION/REMODEL TYPE OF WORK: DETAILED DESCRIPTION OF WORK BAftyn J FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK. Equipment Installed MFG: MODEL: SIZEIBTU MFG: MODEL: SIZEBTU MFG: MODEL: SIZE/BTU $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 _A/C TO AIR EXCHANGEER $15 (WOOD) $35.00 NEW GAS GRILL $10.00 _AIR _FIREPLACE BOILER $35.00 $35.00 _GAS UNIT HTR $10.00 _FURNACE LINER $10.00 GAS DRYER $10.00 OL HEATER $35.00 _CHIMNEY DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00 °'' ? f e�5�r�-f f t "a 'm � "s� `� S•� Y i �,. ��LS $� � a`. �§ 3.^€x i ��' b`yi �� � h .;,5'�" � '3 ,+� k F 'tA 4' � (' , "05 "F� 3"vRn 9.•e� � 5 �� q�+T -..3 £< .: �✓ � � .�,� �'i��YS iv t` r� �' y5i� d { ^�*+.0 f ��� 'K , 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 __+ ., «o...,;+ 1. + .,,,i., an onnl;na+inn fnr a "A. ;t anri wnrlr ;a nest fn Starr withn,lt a nen-nit- that the wnrk will he in accordance with the City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 City of Fridley Residential Mechanical Application Page 2 REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC 0 NEW HOMES/ADDITIONS 0 EXISTING HOME 0 MAKE-UP AIR REOUIRED FOR NEW/EXISTING HOMES 1. Combustion Air (See note below) a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments 2. Make-up Air (See note below) a. IMC Chapter 5 with MN Amendments MN Rule 1346 Sec. 501 3. Venting a. Gas appliances IFGC Chapter 5 with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments 4. Heat loss & cooling load per room a. MN Rule 1322, Sec. NI 104.4.13 5. Ventilation a. Per MN Rule Chapter 1322. Sec. 1104 6. Duct Design Per IMC 1346.0603.2 a. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make-up air calculations. BUILDING PERMIT APPLICANT: PROPERTY OWNER 1, 4 L.— J, ,f gICCL A4 Imo_, understand that the State of Minnesota requires that all residential building contractors, remodelers and roofers obtain a state license unless they qualify for a specific exemption from the licensing requirements. This license requirement applies to owners of residential real estate who build or improve such property for purposes of speculation or resale. By signing this document, I attest to the fact that I am improving this house for my own use and am not building or improving this house for the purpose of reselling it. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building or remodeling on speculation or for resale and that the house for which I am applying for this permit, located at _.Sj -5- �2% , �2 OE— , is the only residential structure I have built or improved in the past 24 months. I also acknowledge that because I do not have a state license, I forfeit any mechanic's lien rights to which I may otherwise have been entitled under Minn. Stat. §514.01. Furthermore, I acknowledge that I may be hiring independent contractors to perform certain aspects of the construction or improvement of this house and I understand that some of these contractors may be required to be licensed by the State of Minnesota. I understand that unlicensed residential contracting, remodeling, and/or roofing activity is a misdemeanor under Minn. Stat. §326B.082, subd. 16 and can also result in a fine of up to $10,000. I further state that I understand that the filing of a false statement with The City of Fridley may also result in criminal prosecution and/or civil penalties to applicable city ordinances and/or state statutes. I have also been informed and acknowledge that by listing myself as the contractor for this project, I alone will be responsible to The City of Fridley for compliance will all applicable building codes and city ordinances with the work being preformed on this property. S' tur caner ®d Date For questions or information on contractor licensing, or to check the licensing status and enforcement history of a particular contractor, call the Minnesota Department of Labor and Industry, Construction Codes and Licensing Division, at (651) 284-5069. The web site is: http://www.dli.mn.eov/Ccid.asR