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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT Date: .. / ../ ............................. Owner ....................................... Address ...................................... N® 358' Builder .`T.... .. .....,/P,'�?.... ................ Address............................................. %% nn LOCATION O,rFF BUILDING No. ..(� PI . / ... Street ... !�f'..L.. ..o. �� .S: • ........ Part of Lot ... ...... . rrte�.. .. .......... .,,,,pp.... Lot ... ...... Block .................. Addition or Sub -Division .� .. � . i/ . 3® . -t o-# Lot . ........ Inside Lot ............ Setback 4. .: .... Sideyard . �i� ...................... ............... DESCRIPTION OF BUILDING T be Used ' A .. .... Front ./... Depth : ® Height Sq. Ft.f ®,1..�. Cu. Ft. .... . . . ... . ... t A a® 9....... Front VI .C:. ® Depth ? E7 Height 5q. Ft .. ..... Cu. Ft. Type of Construction ................... Bet. Cost.—,' i . To be Completed ..............:.... 1 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. �c.��..�. .. ............. ......... 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 j done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of /J 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 J ordinances. *%Vool! Z .......... 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. 33 City of Fridley, Nffim N° 7971 BUILDING PERAUT • Date: JUNE 18, 1965 Owner: RICHARD E. HELM Builder RICHARD E. MM Address 621 - 67th Avenue N. E. Adm LOCATION OF BUILDING No. 621 Street 67th Avenue N . E . Part of Lot Lot 8 _ Block 5 Addition or Sub -Division Rice Creek Terrace, Plat 6 Corner Lot — Inside Lot Setback Sideyard Sewer Elevation ___ _ _ Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction, Cost X18, 000To be Completed • REBUILD FROM CAP UP • In consideration of the issuance to me of a permit to construct the building described above I agree to do the proposed work in accordance with the description above set forth and compliance with a'll provisions of ordinano� of the city of Fridley. e In consideration of the payment of a fee of $ 10.00 , permit is hereby granted to RICHARD E, -MM to construct the building or addition as described above. This permit is granted upon the eupress 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 p� thereof, shall conform in all respects to the ordinances of Fridley, >llinn�ota glocation, construction, alteration, maintenance, repair and moving of buildings wiord naat�:es. dty limitaea�this permit may be revoked at atq► time upon violation of ani► of the provisions of said ALLEN G. JENSEN Building Inqwtor NOTICE M poem dos aet Cora tbo eomtroaOM, imtaiiafton ter wiring, phMbtne, pa hatht& aswv er Watar. Be wn to M tin Bufiding MWedw for separate parmtia for db harm. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA a OWNEW S NAME BUILDER , ! G b�� Y ��� I z? ADDRESS_ l Q l` Y N ,ADDRESS_ L•�( G 7 Ave"Al l LOCATION OF BUILDING -� Street Part of Lot -LOT R ADDITION OR SUBDIVISION Corner Lot`XInside LOT Setback Side -+Yard .-SEXIER ELEVATION FOUNDATION . M"ATIIO Applicant attach to this form Two;Certificates of Survey of Lot and proposed building location drawn on these Certificates. To be used as; DESCRIPTION OF BUILDING Front DepttL Height Sq. Ft. Cu. Ft. Front Depth _Height Sq. Ft. Cu. Ft. Type of Construction_ ®®q� r Yn e- Estimated Cos' 660 To be completed V, /7 l re n aP The undersigned hereby makes application fora permit for the wor heecifled, P 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. (Schedule of Fee Costs can be found on the Reverse Side). P� & . MM.L_ 01 SUBJECT213 PE O: City of Fridley 0 5 AT THE TOP OF THE TWINS BUILDING PERMIT///( COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. Y5 71.,9 �'--1 CITY HALL FRIDLEY 55432 IL NUMBER REV DATE PAGE OF APPROVED BY .... � �'j 612-571-3450 910-F15 4/27/92 JOB ADDRESS 621 - 67th Avenue NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR, 8 5 1 Rice Creels. Tertace flat 6. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Richard Helm 621 - 67th. Avenue NE 5713848 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION [I REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Dwelling (;24 Squaresl 2nd LaXer 9 CHANGE OF USE FROM TO mm STIPULATIONS Roofing can.be..2nd layer.but not 3rd, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $11,272 $,.64 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $31,00 Fire SC., $1.27 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $32.91 -RACTOR OR AUTHORIZED A NT IDATEI HEN OF ARLY VA DA D THIS IS Y UR PERMIT ,SIGNATUREOFC LOG INSP DATE SIGNATURE OF OWNER OW NER BUILDERI IDA E1 01 NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER[ j SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: 7 /" - v a e- 0 Legal Description: Owner Name & Address: Effective 3/1/92 Tel. # 6'7/- 3$'q9,' Contractor: ,d,_ 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 IWROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ ?-2- Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT Tel. #-g7/ CITY USE ONLY Permit Fee $ -3/-00 Fee Schedule on Reverse Side Fire Surcharge $ /, �.l `J .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $700 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ j Not Necessary [ ] TOTAL STIPULATIONS: SUBJECT City of Fridley 278 3 9'7 THE TWINS BUILDING PERMIT 579-T3964 EIPT NO. Ir? ` COMMUNITY DEVELOPMENT DIV. SEC. �j f PROTECTIVE INSPECTION / �/13 1 . � CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 10/23/98 JOB ADDRESS 621 67th Avenue NE / LEGAL LOT NO.BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. $ 5 Rice Creek Terrace Plat 6 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Roxanne & Michael Ricci 572-0709 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Owner 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO B USE OF BUILDING Residential 7 CLASS OF WORK 0 NEW 0 ADDITION 0 ALTERATION Ex REPAIR 0 MOVE 0 REMOVE B DESCRIBE WORK Reroof house and garage (30 Sq) Tear-off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN 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 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 $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 Fire SC $2.57 PLAN CHECK FEE TOTALFEE 78.61 SIGNATURE Of CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPER ALI ATED THIS IS YOUR PERMIT O SIGN E O� O 0 NEP BUIiDERI iDATEIBLOf, INSP flA it NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION 3'� ConstructionAddress: (G Q� U -1 -WA Acse MZ r'ic1l�,_, , YY\ N Legal Description: Owner Name & Address: i'ox 0. A IrVI'i C" 1 !e cc Tel. #—S -7a -0 70-'1 Contractor: Q fir 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 EMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA:Ler n �Width Hgt/Ground Sq. Ft. OTHER: 4� l ��C'> �1 C� Construction Type: r c— Yc)-<n(= Estimated Cost: $�%� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: to Z3 - 9 APPLICANT: Tel. # S--7g-o-709 Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL . STIPULATIONS: /70 CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1000 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] CITY OF FRIDLEY PERMIT NO.: 2004-02039 6431 UNIVERSITY AVENUE NE s FRIDLEY, MN 55432 DATE ISSUED: 12/02/2004 (763) 572-3604 FAX: (763) 571-IL&I ADDRESS : 62167 AVE NE R 6 2 9 3 PIN : 143024130076 LEGAL DESC : RICE CREEK TERRACE PLAT 6 LOT 8 BLOCK 5 PERMIT TYPE BUILDING PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADDITION/ALTERATION VALUATION : $ 6,030.00 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 R317 OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. ALTER BATHROOM. STATE LICENSED CONTRACTOR 1 APPLICANT HOME VALU INC 5401 EAST RIVER RD NE FRIDLEY, MN 55421 - OWNER RICCI MICHAEL A & ROXANNE V 621 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 wort will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or thermance of construction. li Annrant / r 1 1 Date l BUILDING PERMIT FEE 139.25 PLAN CHECK FEE 90.51 FIRE SURCHARGE 6.03 STATE SURCHARGE, VALUE 3.02 LICENSE SURCHARGE 5.00 TOTAL 243.81 PAID WITH CHECK # 079975 SEPARATE PERMITS RYk)UIRED FOR WORK OTHER THAN DESCRIBED ABOVE. NEW [ ] CITY OF FRIDLEY Effective 4/1/2004 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: ("21 67 TP 4 A -le-"- 00 Legal Description: Owner Name & Address: /V11 C,//f eL 9;C6 i Tel. # 7(, 3 - S 7 a - 070? Contractor: 140 vac- VA L L) MN LICENSE # z O 17 S 2 ,S' y Address: S 110 / 4 - 12 / "&z iL o Tel. # 7(,3 S 71 - G / O o 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: C /4 k,-5 e A- -, 1+2 oo r-% Construction Type: !v©o0 F/ij/-,(L Estimated Cost: $ �f� Driveway Curb Cut Width Needed: Ft. + 6 Ft= Ft x = $ ' Cell &/2-eoLf-F73Lj DATE: )0 -d 7-O V APPLICANT: Tel. # %ro 3 - S 7 / - C / o o �i4� 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. Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL 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 $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] STIPULATIONS: 10/27/2004 WED 07:43 FAX 7635022219 HOME VALU INSTALLATION -*$-► DEAN C. 11006 �►.orU/ �1 .ifs <i Ar �.. L� rF t6��5 ?/.?al.,'V.9. all.' -41-4.4 . P/ 1 1. " ,Lh E'er z ` __-4WIf-U4 10444M Fram-M Triage Ottiee 612.913.868T C5&..,N, BAw I ORTROPOSAL 6128633887 T-033 P-003/004 F-727 Rolle yew Cmamw PiL F.im" am M024M pes)IMAW FU ff Z ELRICCI TH AVE NE FRIDLEY, MN Giem wme vnot mmmm CM & Rmord hwer mow Nam, WN Gm W) (01)4W4M7 Fear Phi $ Cl low wend. wmmrdd.t4x 6m p"go.6111 (9N S04610 FOX �= 4o SQ Fr WSTAL'1.- WALLTU 24 LN FT NSTALL BULLNWE (3 OU TCOANMS) 24 LN FT INSTALL D ISTELLOIJ LCOR , MUDWORK - DRYPACK a 30 SQ FT INSTALL FLOOR TILE 30 I FT 10/Z7/ZUU4 Wk;V U7:4Z rAl 7UaOUCZZla riUNC YALU lfl;*lALLAllVA iii Lilm" 4. *jvvv su MO CIN �l Tl It D2 QL a r� C.. 1 _... .. � I u -.1<t In* I . coo Z •� t'tk�:• .:�!:'- :.t' "0;: •: �, - :•.t•...�... rI.'$J`..•:. .n �.Dr' .. ...T':by,y.-1'.u. r�: ' o . ro. 1 t ice•-6Zt.&4 - � ../r,+w.nen• .414°.Yms?i . rf- a i L1 I N N , ;D. ar g vu r CITY OF FRMLEY PERMIT NO.: 2004-02040 r 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 12/02/2004 572-36U4 FAX: (763) 571-1287 REPRINTED ON 12/8/2004 ADDRESS : 62167 AVE NE PLBG PERMIT MINIMUM FEE 0.00 PIN : 143024130076 PLBG FIXTURES (NEW OPENINGS) 30.00 LEGAL DESC : RICE CREEK TERRACE PLAT 6 PLBG FIXTURES (EXIST OPENINGS) : LOT 8 BLOCK 5 WATER TREATMENT APPLIANCE PERMIT TYPE : PLUMBING WATER HEATER - ELEC PROPERTY TYPE : RESIDENTIAL WATER HEATER - GAS CONSTRUCTION TYPE : ADDITION/ALTERATION GAS RANGE FEE VALUATION : $ 0.00 GAS DRYER FEE NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL THREE FIXTURES IN BATHROOM REMODEL. PLBG REPAIR/ALTERATIONS 0.00 # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0 # NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS 0 # GAS DRYERS 0 # GAS RANGES 0 # OF NEW FIXTURES 3 VALUE (FOR MINIMUM CALC) 2500 # WATER TRMT APPLIANCES 0 APPLICANT PLBG PERMIT MINIMUM FEE 0.00 HOME VALU INC PLBG FIXTURES (NEW OPENINGS) 30.00 5401 EAST RIVER RD NE PLBG FIXTURES (EXIST OPENINGS) 0.00 FRIDLEY, MN 55421- WATER TREATMENT APPLIANCE 0.00 WATER HEATER - ELEC 0.00 WATER HEATER - GAS 0.00 GAS RANGE FEE 0.00 OWNER GAS DRYER FEE 0.00 RICCI MICHAEL A & ROXANNE V PLBG REPAIR/ALTERATIONS 0.00 621 67TH AVE NE STATE SURCHARGE, PLBG FLAT 0.50 FRIDLEY, MN 55432 TOTAL 30.50 PAID WITH CHECK # 080069 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 atter 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 regulating construction or the performance of construction Awa t-, A Date / Bldg SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY INSPECTION DIV.Effective April 1, 2004 6431 University Ave NE \ Fridley, MN 55432 APPLICATION FOR PLU I AND GAS FITTING PERMIT�� (763) 572-3604, FAX (763) 571-1287 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR 1. Water Heater �� �� sem:>::>: �i�l<;. >> Wash I•t��::::: Floor � :.;:::: �::� �- :«:<::: .. ::. �::.:::.:.. Auto. ':.� ��< Gas ..... to Urinal ITT. -id ;1Shower Floor 1 Floor 2 Floor 3 Floor 4 Drain PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS I H e t/L New Fixtures $10.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $10.00 3 ® specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $10.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $10.00 and representations stated in this application are true and correct. Catch Basin $10.00 I 7 20 0 Rain Water Leader $10.00 DATE: , Sump/Receiving Tank $10.00 l �! C %�% a L.. Ile/ Water Treating Appliance $35.00 OWNER Water Heater -Electric $35.00 12ese- Water Heater - Gas** $35.00 BUILDING USED AS Gas Range" $10.00« , 't' Z, PERMIT NO. �� 4 ,Gas Gas Dryer** $10.00 ESTIMATED COST Back Flow Preventer Required ( )Yes () No Vz Type $15.00 PLUMBING COMP Y 2. 1 Reinspection Fee $50.00/Hr SIGNED BY w TEL N0. 7)- ALL OTHERS AND/OR REPAIRS AND ALTERATIONS �,� C 1 C Lo .- e• 1.25% of Value of Fixture or Appliance Approved By Rough -In Date Final Date State Surcharge $ • 50 MINIMUM FEE F R ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST TOTAL FEE $ 6. OF THE IMPROVEMENT WHICHEVER IS GREATER ON WORK LESS THAN $300 COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. "PROVIDE COMMON VENT INFO ON BACK SIDE i FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, the undersigned hereby verifies that the BTU Input venting has been examined and is free from rust, deterioration, obstructions, Appliance #2 Type and is securely supported and firestopped where required. Yes () No( ) The venting system is plastic/PVC and meets all current codes and m4nufacturer BTU Input specifications including sizing, length, number of elbows and terminatidn. 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 Vent Height include AGA-GAMA Category I Central Furnace Venting Tables for fan Appliance #1 Vent Connector Height assisted and natural draft appliances. Yes () No( ) The existing combustion air is sized and installed to meet the current codes ft Length and manufacturer's specifications. Yes () No ( ) When required to install a new combustion air, it will be sized and installed ft Diameter in Type 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 Fumice Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) IS the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes () No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date: From: unknown Page: 1/5 Date: 4/9/2008 4:31:23 PM F763-502-4970�7.FAX ig ns BUILDINC>< Sp Inspec-360 RESIDENTIAL APPLICATION -31404 -4977.F CITY OF FRIDLEY �4YU1IR rI• p RiSSANT IS: ©OWNER YJi ()NTR.ACTORA%I4T NSR! NAMC;_�> 4.--- C� e ADDRF$S::,_�'� f's- PHONE:_•—.?+'��.9 1 CONTRACTOR SUBMIT A COPY OF YOUR 5TA7'E I.ICENSI? TYPE OF WORK-. DE9CRIBE WORK BEING DONt. SIZE DF IMPROVEMENT I+INI' NUMBER OF SQUARES A .y PROPOSED SIZE: PROPOSEr) micAT. - ADDRF.5S:*lit' a.i .� Q PHONtS •- 3 s�/ _Cl'!'Y IrAX STATE LICFNSL#�.o S rXP DATE SINCII.r FAMfI.Y/NLW CONSTRklC'I'ION ❑ % FAMILY/NFW CONSTRUCTION ❑ ADDITi N iO GARAQ 0 ISASF,MF,NT FINIS14 M ROOF 13 DECK ❑ SIDING 13NFW HOMFCONSTRUC ION ❑ MAINTL••NANC AEPA1R C] Vinyi 0 Ahanintrm D Othor _ VMMQWI IN EXISTING OPFNINGS MYes Ra OR FOR NEW ()PF.NIN(351DFSCRIBE SITE OF OPEIVINO CHANORS & Permit Foc Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Win Church W CI HOOSE ONLY Cl t IOUSF. &' GARACC ❑ ATTAC HF.n GA RAGE Cl DETACHED GARACIF, ©Soffit O Trim ❑ f a.%to I.00 ION UP WINDO (USING THE 19971188 Iri:F: SVIRDULE) THIS IS AN APPLICATIC I homby apply far a lualdine- t1Cnn11 and I acknawtedpo that the fnfornmti of the City of Fridley t tltu Minnesota Conatnlelitm t'ndos that r pwmft nn site; that work wi in accordance fth rho I V Inn SIONATURR OF APPIACA T APPROVCD BY Ll DRAIN TILE ❑ OTHER Permit No.: Received By: Datc RWd�Qi STATE- sTgTE t_16zrp S"$'0_2-) BAS .ENT CMODF7 }N- G INUO vjIT 1. Existing I'loor Plant 2. Proposed floor plats 3. I.IsI aratructurnl mcmbNus to be Iteed FOR NEW CONSTRUCI•ION INCLUDING DECKS, AnDJ-T N9 4 X)RCH; 5119MJ'C: 1. Site Plan/Survey showing rho existing vtrucmrm anal pmpnsed pmject. 2. Two seta of consttueiion Plans 3. Energy Calclllaliuns See Bark- Page for Fee Sohcdule - 65% of Bullciing Permit Fee •001 times the total job valuation 0005 x Pcr nIt Valuation Minimum 5,50 $5,00 (State Licensed Re9idential Contractors) $1825 per SAC Unit (Plans to IWWCC for determination) tt+eft- ftx$21 =S $00 Conservation Plan Review Fee Dctermincd by Engineering Agreement necegsary ( ) Non Neeessary ( } FOR A PERMIT -NOT VALID I INTIL PROCIZSFD almw is eomplulo and Rocuratc; dull the wnrk will be fn confarmanco v Ith the Ord no cm eois n` idurtrtnnd this is nnl u permh knit only tin application fand or a permh and work is not to sten without a the erose ofnll work >v11ich rcgtlims rtvleW Ilnd at>proenl of plans. 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