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# 0 City of Fridley, Minn. BUR DING PERMIT N® 3247 Date: ..... ....................... Owner.......................................Builder cle,. �c ��., ��t3 �;............. Address ...................................... Address ............................................. L LOCATION OF BUILDING No. ... Street . F':'.. �` ......... Part _ f aLot ... .. Lot �....... P.... Block ..... ........... Addition or Sub-Division��:. :. ! S �, :�✓�'. ... lD':a'^ s � _ Corner Lot ............ Inside Lot ..... ,...... Setback ..: A'...... Sideyard .�. ::'e: ........... DESCRIPTION OF BUILDING oe Used as:� . .... .'.:............ Front / . Depth �— ... Height ... Sq. Ft.Cu. .................... Front ........Depth ........ Height .... Sq. Ft. ........ �Gu. Ft. ........ Type of Construction ��.`..... .......Het. cost.` ... . ..... To be Completed .. ....... . f 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 $. r...:......, permit is hereby granted to...... . ....... . • • • ................ to construct the building or addition as described above. This pern4 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. Inspector NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plumbs , gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. • • City of Fridley, Minn.. BUILDING PERMIT N® 7-490 Date: May 22, 1965 OwnersErnest Harry Builder Inter City Garage Builders Address -950 67t Ave. N.E. Address 35 Hwy. 10 Mpls 33 No. 650 Street Lot 1 a —__ Block Corner Lot Sewer Elevation To be Used as: Type of Construction LOCATION OF BUILDING 67th Ave. N.E. _ part of Lot 6 Addition or Sub-Divisiorpice Creek Terrace Inside Lot Setback ___ _ Sideyard Foundation Elevation DESCRIPTION OF BUILDING Front — Depth Front Depth Fast. Cost Repair storm damage on house Height Sq. Ft. Height Sq. Ft 2600---- To be Completed _ Plat 6 Cu. Ft Cu. Ft. 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 city of Fridley. A 10.00 - Inter -City In consideration of the payment of a fee of $ , permit is hereby granted to Garage Builders 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 ofbuildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. Building Inspector NOTICE: ihb permit does not cover the construction, hutaMon for wiring, Plumbing, on heating, sewer or water. Be euro to see the Building Inspector for separate psrmhs for thus Nemo. APPLICATION FOR B'- ING PERMIT ,„ CITY OF FRIDLEY0WEINNESOTA OWNE'R'S NAME-&"/- BUILDER kro 4 1, ' / d ' LOCATIONBtdDllqG No. Oro StIte,jet Part of Lot -.y SubdivisionLot lock Additiorr or fir'' Corner Lot Inside Lot x.,.Settsack Side -Yard SEWER ELEVATION FOUNDATION EUVAtION Applicant attach to thin form, Two Certificates of,Survey of Lot and. proposed build- ing location drAVn on these Cettificates . To be used as: DESCRIPTION OF BUILDING PronC Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction (� Estimated Cost v.MVS The undersigned hereby makes application for a permit for the.work herein specified, agreeing to ao all work iii 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. 7- 43 Schedule of Fee Costs can be found on the Reverse Side). G� FIRM STAMP S4) -6-/6 7 Z) CONTRACTOR'S JOB COST ESTIMATE FORM-NO.155 Name Phone -a)4/6 Date Street D 6 City State Location of Job Sheet No. Estimator Checker Estimate No. Terms BCost Basis of Bid Plus Definite Bid Other Job to be Commenced To be Finished Description of Job QUANTITY UNIT LABOR DESCRIPTION MATERIALS - EMPLOYMENT PRICE HOURS RATE EXTENSIONS TOTAL C 0 f T I T ALS r FORA NO. 155 - THE BLACKBOURN SYSTEMS. INC.. MINNEAPOLIS S. MINNESOTA City of Fridley, Minn. N° 8115 • BUILDING PERMIT Date: July 6, 1965 Owner: Ernest Harry Bider Inter City Garage Builderst Address 650 67th Avenue N. E. Address 35 Hwy 10 Mpls., 33 LOCATION OF BUILDING No. 650 Stmt 67th Avenue N. E. Part of Lot Lot 1 __ Block 6 Addition or Sub -Division . Hiae Creek Terrace, Plat 6 Corner Lot Inside Lot _ _ Setback Sideyard Sewer Elevation __.__ Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Garage & Patio Front 22 _ Depth _30 _ Height 1QSq. Ft - 660, Cu. Ft 6600 Front Depth Height Sq. Ft. Cu. Ft Type of Construction Frame Est, Cost I? -000• 0 0---- To be Completed • Patio and Garage • In consideration of the issuance to me of a permit to construct the building described above I agree to do theproposed work in accordance with the description above set forth J)* compliance with 21 provisions of ordinanc:ea of the city of Fridley. I In consideration of the payment of a fee of $ 6'� , permit is hereby granted to Joseph bhun 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 saggid building, or anyctipoanrt thereof, shall conform in all respects to the ordinances of theolimitsr�en�this p�ermi�t � be okedcia any time�upon�o a13 n of anydof the �visio �of�said ordinano�. Allen Jensen Building Inspector NOTICE: M puM don trot oawr the eonstr Wen, dnhMan for rririn& plumbing, gas boding, sawar or wdw. Be wn to we tho Buif lig trspotar for ssparata pormhs ter thao hour. OWNER'S ADDRESS APPLICATION FOR BUILDING PERMIT -CITY OF FRIDLEY, MINNESOTA LOCATION OF BUILDING No. % �a — Street, /IT Part of Lots LOT BLOCK w ADDITION OR SUBDIVISIO naide LOT_, Setback Side -Yard Corner Lct�I^` SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed }wilding location drawn on these Certificates. DESCRIPTION OF BUILDING To be used as; V P Front•^Depth 30 Height.A. Sq. Ft. b V Cu. Ft.� Front Depth Height Sq, Ft. Cu. Ft. Type of Conatruc t ion—AR &M e Estimated Cost ,�UD D � To be completed V V 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 (� _� 6 SIGNATURE (Sc edule of Fee Costs can be found on the everse Side). Rd V P G' City of Fridley SUBJECT P 17132 AT THE TOP OF THE TWINS BUILDING PERMIT r R • ___ COMMUNITY DEVELOPMENT DIV. r j PROTECTIVE INSPECTION SEC. I 9 � 1O CITY HALL FRIDLEY 55432 1'' NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 5/11/83 JOB ADDRESS 650 - 67th Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 6 1 Rice Creek Terrace Plat 6 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ernest Harry 650 - 67th Avenue N.E. 571-6142 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Scottom, Inc. 1742 Wildhurst Lane Mound 472-6188 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Construct a 24' x 15' Addition With Basement 9 CHANGE OF USE FROM TO STIPULATIONS Provide products of combustion fire alarms on both levels. Provide combustion air to new- fireplace or existing furnace. $° gP %. r �-- '�A Before digging call local utilities SEPERATE PERMITS REQUIRED FOR WIRING TELEPHONE -ELECTRIC -GAS Etc. HEATING, PLUMBING AND SIGNS. REQUIRED BYLAW 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 SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION 32 OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $17,400 $8.70 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE R LOCAL LAW REGULATING CON- $128.50 NONE T UCTION HE PERFORMAN OF O TRUCTION. AN CHECK FEE TOTAL FEE e $32.13 $169.33 SI NATURE OF CONTRACTOR OR AU ZED AGENT (DATE)ri NWHEN PROPERLY I TED T IS YOUR PER IT t/ BLDG iNSP E SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) In CITY Of FRIDLEY Effective Aug. 1, 1961 APPLICATIM FOR RESIDENTIAL BUILDING PERMITS (Rew. Alterations. Additions. or Repairs) OWNER: BUILDER: c� ADDRESS: Cab ��2��c �� � ADDRESS: TEL M0: TEL N0:-112— Construction Location STRMT aro: STMMT: �°� � � KK • - IAT: _ BLoac: ADDITION:�� L° "z �� lam@ , '�L Corner Lot: _ Insiae Lot: Setback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTIOR OF COMSTRUCTION e 1Front: Depth: �� Height: 42 Square Feet: 360 Cubic Feet: Front: Depth: height: Square Feet: Cubic Feet: _ Type o Oonstruetion: _ Abze- -c-, t cel - ; ` fate 'C&� Estimated Cost: S ` c � e� zb Be Cbr-pleted: Alt. Alt. 8 Proposed Driveway Width if New Opening Is Desired: $ S v VERSE SIDE. OF SHEET site undersigned hereby makes application for a permit for the work herein specified, agreeing to do ,all work it, strict accordance With the City of Fridley Ordinances and rulings of the Deii.nxbnent of Buildings, and hereby declares that all the facts and represontations stated in this applAqation are true and-zx:krrect. DAM `S- Lk - '��-3, SIGNATUIE: V stipulations: Su P e. 32,13 I X9,33 139- L c- C�� (Z ) Mu*mEnFNGINEER.IN4 Co, lNc, ENGINEERS AND SURVEYORS LAND SURVE.YIIJO CIVIL. it MUNICIPAL ENOINECRING SOILS TESTING LAND PLANNING G418 -56TH AVENUE N. MINNEAPOLIS TF.MINN. KE T- SG37 POOL 1 O1� I bs 'oI UF Ie aDin ,'� + ' i _ ._) ^ t .•r `— / — , 'It by Building Inspector �p�ro If r � WE HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF TME LAND ABOVE DESCRIBED AND OF THE LOCATION OF ALL BUILDINGS, IF ANY, THEREON , AND ALL VISIBLE ENCROACHMENTS, IF ANY, FROM OR ON SAID LAND. MINDER ENGINEERING CO., INC. DATED THIS DIY OF r AA.195 ENILItJEERS AMO SURvEYOQS by -Ory 01 SUBJECT PE City of Fridley 19168 AT THE TOP OF THE TWINS BUILDING P E R M I T ' R ' COMMUNITY DEVELOPMENT DIV. ~ INSPECTION SEC. r PROTECTIVE L CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY --_- '� L 612-571-3450 910-F15 9/14/87 / f JOB ADDRESS 650 - 67th. Avenue N.E. 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 6 Rice Creek Terrace Plat 6 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ernest Harry 650 - 67th Avenue N.E. 571-6142 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. American Remodeling 3700 Annapolis Lane, Mpls. 55441 553-0020 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 Ek REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside Dwelling 9 CHANGEOFUSEFROM TO STIPULATIONS SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $7,500 $3.75 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIO ANY TE OTH STAOR LOCALREGULATING CON- ,,OW STR C ON O TH E R ANCE CTION. $68.50 DO�FN PLAN CHECK FEE TOTALFEE y 9 /5l $72.25 SI ATUREFCONTRACTOR AUTHORIZED AGENT IDATEI _ HEN PROPERLY IDATED THIS IS YOUR PE MIT SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI BLDG )NSP DATE 01 NEW [ ] City of Fridley Effective 4/1/86 ADDN. [ ] �R-1 AND R-2 ALTER. [ ] Building Permit Application Constructi, Legal Desc, Owner Name Contractor Address Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: Length GARAGE AREA: Length DECK AREA: Lengt OTHER: DESCRIPTION OF IMPROVEMENT Width Width Width Height Height Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback Type of Construction: Estimated Cost: $ Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation `S S 3 DATE: f7114118f7 APPLICANT: Tel. CITY USE ONLY Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $ 525 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] 20 SUBJECT PER City of Fridley 27586 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r 1 � NUMBER REV DATE PAGE OF APPROVED BY = CITY HALL FRIDLEY 55432 612-571-3450 910-F15 9/4/98 JOB ADDRESS 650 67th Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 6 Rice Creek Terrace Plat 6 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ernie Harr 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Exterior Design Service 6391 Monroe St NE Fridley EN 55432 571-3220 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 jj REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage (22 Sq) Tear -off; Siding repair 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. Call for building wrap inspection before covering. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 3385 $1.69 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PRIWISIONSIOF ANY OTHER STATE OR LOCAL LAW REGULATING CON- ST TION R THE PERFORMANCE OF CONSTRUCTION. $87.25 Fire SC $3.38 PLAN CHECK FEE TOTAL FEE License SC $5.00,1 1$97.32 NATURE OF cloNTACTOR OR AUTHORIZED AGENT IDATEI Aw&"- HEN PROPERLY BLDG NSF' /A (DATED THIS IS YOUR PERMIT - 1 —w DATE SIGNATURE OF OWNER(IF OWNER BUILDER) IDATEI NEW ADDN [ ] CITY OF FRIDLEY . ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION 6s -(-)N ConstructionAddress: /A ;7 Legal Description: Owner Name & Address: 4 h r 'M4 /-,v Tel. # Contractor:r-; vv MN LICENSE # Address: 6 3 rA Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Effective 1/1/98 Tel. # 3^7/- 3 zz-© 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: / i Q®/��'k f' ��k �t� timated Cos . $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: Tel. # `71— 3� z CITY USE ONLY STIPULATIONS: Permit Fee $ C6-)'? Fee Schedule on Reverse Side Fire Surcharge $ J. j .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1000 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 $ STIPULATIONS: CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 5.00 $ Future Fixtures $ 0 $ Water $ 1.50 $ Beer Dispenser $ 4.00 H Blow Off Basin m O W b N W W 4 W $ M Heater 5.00 $ O $ 5.00 i1 Sump or Receiving Tank $ 0 y O 8 7.00 Y a) Hot Water Heater W N $ Gas Range U,O o $ Gas Dryer to 3 o w° to w u 11 Type $ 5.00 o lec y 1st 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 5.00 $ Future Fixtures $ 3.50 $ Old Opening, New Fixture $ 1.50 $ Beer Dispenser $ 4.00 $ Blow Off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ Hydraulic"Valve $ 5.00 $ Sump or Receiving Tank $ 5.00 $ Water Treating Appliance $ 7.00 $ Hot Water Heater $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ Back Flow Preventer Required. . . Yes ( ) No ( ) Type $ 5.00 S ALL OTHI::•S AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance $ State Surcharge $ .50 Reinspection Foe $ TOTAL FEE $ Effective Date May 1, 1988 Job Address -yVy� � LL) Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. �, 19—q L OWNER KIND OF BUILDING J {•-U='r1-t`W, `EST 6-5 i 6-711-1 AVB\ E I°dM"(H EAST USED AS FRIDL- Y, 11� 5-94= TO BE COMPLETED ABOL. is W 57.1."-86559 ESTIMATED COST L f V 6 -ori !F-�j-- // OLD - NEW BUILDING PERMIT NO. PERMIT NO. ( n Companyr Signed ByQ Tel. No. ROUGH INSP. Date l FINAL INSP. Date APPROVAL FOR PERMIT X� MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY PERMIT NO.:004-01053' 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 07/07/2004 (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 650 67 AVE NE PIN : 143024130078 LEGAL DESC : RICE CREEK TERRACE PLAT 6 LOT 1 BLOCK 6 PERMIT TYPE PLUMBING PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADDITION/ALTERATION VALUATION $ 400.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL A GAS WATER HEATER. # ELEC WATER HEATERS 0 # NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS 1 # GAS DRYERS 0 # GAS RANGES 0 # OF NEW FIXTURES 0 VALUE (FOR MINIMUM CALC) 400 # WATER TRMT APPLIANCES 0 APPLICANT PLBG PERMIT MINIMUM FEE PLBG FIXTURES (NEW OPENINGS) 0.00 0.00 NORBLOM PLUMBING CO 2905 GARFIELD AVE S PLBG FIXTURES (EXIST OPENINGS) 0.00 MINNEAPOLIS, MN 55408-2173 WATER TREATMENT APPLIANCE 0.00 (612) 827-4033 WATER HEATER - ELEC 0.00 WATER HEATER - GAS 35.00 GAS RANGE FEE GAS DRYER FEE STATE SURCHARGE, PLBG FLAT 0.00 0.00 0.50 OWNER HARRY ERNEST H & LORRAINE V 650 67TH AVE NE TOTAL 35.50 FRIDLEY, MN 55432 PAID WITH CHECK # 28580 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating co ,ntruction or the performance of construction. At Date Bldg Ins Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. -PITY OF FRIDLEY INSPECTION DIV. Effective April 1, 2004 ;431 University Ave NE =ridtey, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Ip��° 763) 572-3604, FAX (763) 571-1287 MARK N11MRFR nF FI)M IRFS Tn RF IM.RTAi I Fn nM PAPP Gi nnP 1� 3LUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS_ 6aAA&*. - aS o'W A14- 4ew Fixtures $10.00 The undersigned hereby makes application for a permit for the work herein )Id Opening, New Fixture $10.00 specified agreeing to do all work in strict accordance with the city codes 3eer Dispenser $10.00 and rulings of the Buildinq Division, and herebv declares that all the fads Now Off Basin $10.00 and rel HARRY, ERNEST ;rue and correct. ;atch Basin $10.00 650 67TH AVENUE NORTHEAST '^ a (0I 23 DLf lain Water Leader $10.00 FRIDLEY, MN 55432 Sump/Receiving Tank $10.00 .20 (763) 571-6142 Nater Treating Appliance $35.00 OWNEF. Nater Heater -Electric $35.00 Nater Heater - Gas" l $35.00 � BUILDING USED AS I4$I d11 e+ 1C_e_ Sas Range" Sas Dryer"' $10.00 $10.00 ESTIMATED COST �� oD PERMIT NO. L"C) 3ack Flow Preventer Required ( )Yes () No Type $15.00 ^ ' 11 `_ PLUMBING COMPANY IVO C�` OVA ► 1.(Ayvt IDtJlo, V Reinspection Fee $50.00/Hr SIGNED BY TEL NO. (lo12) $27-cl033 kLL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance Approved By Rough -In Date Final Date State Surcharge $ TOTAL FEE $ � _,SD OF THE IMPROVE NT WHICHEVER IS GREATER PLUS THE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. "PROVIDE COMMON VENT INFO ON BACK SIDE 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 venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes ( ) No( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes ( ) No( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes ( ) No( ) When required to Install a new combustion air. it will be sized and installed to meet the current codes and manufacturer's specifications. Yes ( ) No ( ) When Installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes ( ) No( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes ( ) No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Tctal 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 MECHANICAL Permit No.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Dated: A Ah 763-502-4977 FAXc� Kt� U EFFECTIVE 2-19-09 DATE �'-�'- / YOUR E-MAIL ADDRESS // SITE ADDRESS la-50 a^e A C- THIS APPLICANT IS: ❑ OWNER )dCDNTRACTOR PROPERTY NAME: Ern es -k- OWNER/ ADDRESS: S r CITY STATE ZIP TENANT �- PHONE: CONTRACTOR COMPANY NAME: a SUBMIT A COPY OF CONTACT PERSON YOUR STATE STATE LICENSE # ' E DAYE LICENSE WITH ADDRESS: Midlay, MN 2 CITY STATE ZIP APPLICATION PHONE 754-2199 Fax (t7) 754-2005 PERMIT TYPE ❑ SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW ALREPLACEMENT ❑ ALTERAnON/REMODEL DETAILED DE CRIPTION OF WORK 71�=WgAirt*' Q1 7 FEES ARE BASED ON $10.00 PERYIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) Equipment Installed MFG: MODEL: SIZE/BTU MFG: MODEL: SIZE/BTU MFG: MODEL: SIZEBTU -/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 _BOILER $35.00 _FURNACE $35.00 _GAS UNIT HTR $10.00 CHIMNEY LINER $10.00 _GAS DRYER $10.00 _POOL HEATER $35.00 _DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00 3 i �'t ZN?1 t ?tE Y IN 4 vs °�as _ P3 er 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 wor ch reqs ' es review and approval of plans. SIGNATURE OF APPLICANT lt0 PRINT NAME �hVjS Papa ^I�� DATE 7- 9ir € 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 ❑ EXISTING HOME 0 MAKE-UP AIR REQUIRED 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 3. Venting a. Gas appliances IFGC Chapter 5 with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooling load -per room a. Required on new construction IMC 1346.0312 5. Ventilation a. Per MN Energy Code 7670 or 7672 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.