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PRE 2010 DOCSCITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 572-3604 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Washrirllt>`=1 Floor Auto. Ce;;<:::::: Gas :M iSC:<: Water Hea ter Stori es dset. Urinal a T�ti'<I>II: h ....Sown;::::::..:: ,.,,...:,.:. :....:.:... e�'�...ktl�< Tray Fe�gi�� Drain `B..BiS��i�: Washer ��"`,.`1�<� Ran e � ;. "'''��. . ..,pp........ 9 h"1!M. Gas Elec Floor 1 Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas 1 Gas Range Gas Dryer Back Flow Preventer Required ( )Yes () No Type $7.0077,00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 16, 6O $10.00 $10.00 $5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance State Surcharge .50 TOTAL FEE $, ewe JOB ADDRESS ?9 / - 61/A l' W, Al. E The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work In strict accordance with the city codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. 1 Building Used Estimated Cost PERMIT NO. ANnI-% PLUMBING COMPANY SIGNED BY oY TEL N0A �N5 Irl Approved By Rough -In Date Final Date 1- Z 0 -9 3 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE SUBJECT P City of Fridley 215 8 3 AT THE TOP OF THE TWINS P, BUILDING PERMIT r COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. 5/ r i = CITY HALL FRIDLEY 55432 �j NUMBER I REV DATE PAGE OF APPROVED By 612-571-3450 910-F15 9/30/92 JOB ADDRESS 991 - 67th Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 1 Michael Servetus Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Brickner Builders. Inc. 6240 Hwy 65 #201, Fridley, MN 55432 574-9871 3440 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 C� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Const-ruct a 421 x 471 Dwelling and a 27' x 22' Garage SEPARATE 8 CHANGE OF USE FROM �jQ� WIRING, HEATING, PLUMBING AND Sl STIPULATIONS See notations on plan, City Council approved on 6/29/92 a front yard setback. variance to 17.5 feet. Provide a hard surface driveway and sod in the frontand side yards. Provide City with copy of verifying survey before capping. SEWER LOCATION: Service from M.H. (Inv. 863.60) 4" Service due North of M.H. MINIMUM TOP OF FOOTING: 866.60 WATER LOCATION: Appox. 10' E of Sewer Service. ������� DRIVEWAY DEPRESSION COST: N/A Before digging calf for THE CITY OF FRIDLEY DOES NOT GUAPMNTEIc THE all utility locations ACCURACY OF UTILITY LOCATIONS AND ELEVATIONS.4540002 THIS DATA IS FOR INFORN1ATION PURPOSES ONLY REQUIRED BY LAW AND PERSONS USING THIS J.NFORMATjo N SHOULD VERIFY IT ON THE SITE. 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 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 'HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 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 $100,895 $50,45 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE $700.00 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $643.00 Fire SC $100.89 STRUCTION ORT E PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE License SC $5.00 TOTAL FEE $ 1,499.34 C� © ja5 �nk_ /' "- SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IOATEI HEN OP Y VA D D THIS IS YOUR PERMIT a �y1 LDG INSP PATE SIGNATURE OF OWNER IIF OWNER BUILDERI (DATEI NEW [ ] Effective 3/1/92 ADDN [ ] CITY OF FRIDLEY ALTER] ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: c/ 9/ 6_7 Lt, a U E N �1 Legal Description: (-OT �' R L ®C k! M I c o t L 5 FR U ET Ik S A D Q J T) D n Owner Name & Address: 0 (C) oc ry C (L e) u I (-D ciZ S .Sni L Tel. # 57 y - 9 k 7 1 Contractor: 43fU CK vU& K i3 L i L D EOLS Z-AAC MN LICENSE # D o j 3 y y (7 Address: Tel. # 5-7 2-9& 7 1 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 "271, Width 4.2' Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: A o 46pC Comer Lot [ ] Inside Lots [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Orn i) F,d� f) 61 k Estimated Cost: $ 10r, Approx. Completion Date: Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ (Cost on Back) _$ I�76e�c� DATE: APPLICANT: ` G.� (�1�_,� Tel. # 5-7 2 CITY USE ONLY Permit .Fee $ ® Fee Schedule on Reverse Side Fire Surcharge $ 00 .001 of Permit Valuation (1/10th%) State Surcharge $ 5' $.50/$1,000 Valuation SAC Charge $ 7 , 0 0 $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 [ ] Not Necessary [ ] TOTAL $ A STIPULATIONS: L U T� -MiW w � I , 10, RNDERSON'S archite turaJ consultants 1000 6� ST. t. E. OSSEO, ON. 66369 ML (02 )-424-9771 -- Plan " �� -'� �- Date Owner, Contractor- Site ontractor• Site Address: PHONE ()TOTAL EXPOSED WALL AREA 2 sq. ft 2) TOTAL EXPOSED ROOF/ICEILING AREA sq ft. x "U WALL AREA CALCULATIONS: TOTAL WINDOW AREA I� sq.ft.x "" "U'= 1 GLAZED TOTAL DOOR AREA sq.ft.x"U" '01 TOTAL GLASS DOOR AREA �o sq.ft. x "U"" GLAZED TOTAL FIREPLACE WALL AREA TOTAL WALL FRAMING AREA NET INSULATED WALL AREA sq.ft.xlU""— TOTAL RIM JOIST AREA TOTAL FOUNDATION AREA (EXPOSED) sq.ft.x"U" TOTAL FOUNDATION WINDOW AREA sq.ft.x"U"--- 3) TOTAL If item 3 is the some as, or less than Item 1, you have met the intent of 2 MCAR 1.16008 A and 0. ROOF/CEILING CALCULATIONS. TOTAL SKYLIGHT AREA TOTAL ROOF/PEILING FRAMING AREA NET INSULATED ROOF CEILING AREA q 1� % iq.fi.x"U"" i S4.ft.x"U°.®Z-?;= .v 4) TOTAL . Z If item 4 Is the same as,or less than Item 2, you have met the intent of 2 MCAR 1.16008 A and 0. ALTERNATE BUILDING ENVELOPE DESIGN To utilize the total envelope system method, the sum of Items I and 2 shall be greater than the sum of Items 3 and 4. . 3) +4) a I hereby certffy thot the building here described meets or exceeds State o Soto Energy Conservation Act. (slgned) CONSTRUCTION RAMING SECTION Interior ofr film 0.68 St inches of soft wood G �� exterioi air film 0.17 TOTAL R I I o y U c 1/R ' 01 'ECTION (INSULATED) Interior air film 0.6$ g.,w— ,4S exterior oir film 0.17 TOTAL R Lz .I-1 U = VR , 2=4_ )IST SECTION 1 interior oir film 0.6$ 2 tEt R�"+ 119, o 3 l k " 1. 4 f 96-Jll"NEWC 5 5 exterior oir film 0.17 TOTAL R - to U = 1/R alle ATION SECTION I interior oir film 0.6$ 2 1j15+T¢o 3 It L --ti v ts- I F 1Z 4 exterior oir film 5 0.17 TOTAL R 1= U = 1/R '� VENTED CONSTRUCTION CEILING SECTION (INSULATED) (( (interior air film 0.61 (4 exterior air film (still) 0.61 TOTAL R 4'9.-79>- U 5.-7P8 U = I/R CEILING FRAMING SECTION (l interior air film 0.61 (2 °�'B ShTaex,L ,Slo (4 interior air film 0.61 (5 3* inches of soft wood 4,r,5 TOTAL R U = I/ R I DZtP CEILING SECTION ( INSULATED) ( 1 interior air film 0.61 (2 (3 (4 exterior air film (still) 0.61 TOTAL R U = I/R CEILING FRAMING SECTION _ ( l.interlor air film 0.61 (2 (3 (4 interior air film 0.61 (5 inches of soft wood _TOTAL R U = I/R EXPOSED BEAM CEILING SECTION (.1 interior air film 0.61 (2 (3 (4 (5 exterior air film 0.17 TOTAL R CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Effective On January 1, 1991 Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace Gas Piping (Needed with new furnace) Gas Range Gas Dryer "Air Conditioning - All Sizes Rate TOTAL $ 20.00 $ p, 00 040 $10.00 $ $ 10.00 $ $ 10.00 $ $ 10.00 $ 0. 099 All Others/Repairs & Alterations (LIST ON BACK 1 % of Value of Appliance or Work Commercial/Industrial 1 % of Value of Appliance or Work State Surcharge TOTAL FEE JOB AD - 6 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 ruling of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. //- 9 ,194 BUILDING USED ESTIMATED COST . do PERMIT DESCRIPTION OF FURNACE AND OR BURNER $ No. of Heating its Circle One (Steam) (Hot Water) (Warm Air Trade Name Size No. - BTU -S-0, _HP ED R $ Fuel Total Connected Load 5Co �g O $ .50- s -"al -6 50 $ � o MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Burner Trade Name Size No. BTU HP EDR HEATING Signed Tel No. 4TiK© 777 Approved By Rough -In Date Final Date I J Z0 1 9/3 FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes ( ) No ( ) 2. Is free from rust or deterioration Yes ( ) No ( ) 3. Has no foreign objects lodged within Yes ( ) No ( ) 4. Is securely supported Yes ( ) No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes ( ) No ( ) 6. Has total heating BTU's of All other BTU's TOTAL BTU' •s Remarks List Alterations Being Done: HEATING COMPANY Signed By Date G7YOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287 February 11, 1993 Brickner Builders 6240 Highway #65 NE, #201 Fridley, MN 55432 Re: Final Inspection at 991 67th Avenue NE, Fridley Dear Sirs: A final inspection was conducted on February 10, 1993 of the above address and the following items were noted which must be completed before the structure can be finaled: 1. Provide sod in the front and side yards by June 15, 1993. 2. Provide a hardsurface driveway by June 15, 1993. 3. Provide stoops at the garage and patio doors by June 15, 1993. 4. Finish cement at windows in basement by March 1, 1993. 5. Firestop and draftstop tub openings by March 1, 1993. We will expect this item to be completed by the scheduled dates and reinspection called for. If you have any questions on this matter, please feel free to contact me at 571-3450. Sincerely, CL' DE E. WILEY Building Inspector M suerecT PERMIT NO. City of Fridley 2691 7 AT THE. TOP OF THE TWINS ?-, BUILDING P E R M I T r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r NUMBER REV DATE PAGE OF APPROVED BY �•� CITY HALL FRIDLEY 55432 L 612-571-3450 910-F15 7/30/98 JOB ADDRESS 991 67 Ave 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR, S 1 Michael Servetus Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Tom Sevensk 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Heiderscheid Bros Const 716 1434-497R 2011601S4 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 O ALTERATION] REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Reroof house and garage 28 S Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING, HEATING, TYPE OFCONST. 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 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 WOR I BE COMPLIED WITH WHETHER SPECIFIED O NOT. THE G NG F A PERMIT 2 DOES NOT PRES E TO E O 1 Y TO VI E OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF NY R E LOCAL REG LATING CON- ST ON O HE E 0 CE CONS TION. $74.75 Fire Sc 2 .33 PLAN CHECK FEE TOTAL FE SIGNATURE(OF CO T TO OR AUTHORIZED AGENT IDAT _ N ROPERLY LIDATED T IS v 06CG INSP YOUR PERMIT �1ATE S,GNATURE OF OWNER I iF OWNER BUILDERI MATEI M NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 \J\ BUILDING PERMIT APPLICATION ConstructionAddress: Legal Description: act Owner Name & Address: 2�—o Tel. # Contractor: &A)s% MNLICENSE#, Address: f (v i % 40E, IJP Attach to this application, a Certificate of Survey of the.SDj j lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EWROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Lefijth W' th H Ground Sq. Ft. OTHER: Construction Type: G � Estimated Cost: $ X3,3 (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = F $ DATE: r APPLICANT: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY $� �� Fee Schedule on Reverse Side $ -2•-33 .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 [ ] sueaEcr P NO.27078 City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC.633 r NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 1'' 612-571-3450 910415 8/10/98 /10/98 JOB ADDRESS 991 67 Ave 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 1 Michael Servetus Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Tom Svensk 574-0837 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Norling Exteriors inc. 341 79 Way - 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 0 ADDITION 0 ALTERATION REPAIR O MOVE 0 REMOVE 8 DESCRIBE WORK Reside House 9 CHANGE OF USE FROM TO STIPULATIONS Call for building wrap inspection before covering. 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 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 10180 $5.09 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 O THE PERFORMANCE OF CONST CTION. $174.75 Fire SC $10.18 PLAN CHECK FEE TFEE r License 5.01$75'.02 IGNATURE OF CONTRACTOR OR AUT ORIZED AGEN IDATEI N P OP BLQjfiNSP ALIDA THIS IR �71�)k TATE SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: / �F/ C 7 �y Legal Description: Effective 1/1/98 Owner Name &Address: % a� E P Tel. # _ S 7 e/- & 3'z Contractor: Nop--111 � ��,,. 119 , AUC', MN LICENSE # Address: 1 10 A Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Tel. # f r, 4 - .7T3C 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: Re 6 U& Estimated Cost: $ 10, ) (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: - /b - APPLICANT:, GUoZt,. y Tel. #�S18 Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL . STIPULATIONS: CITY USE ONLY $ % �%`/ %S Fee Schedule on Reverse Side $ 16-160 .001 of Permit Valuation (1/10th%) $ $.50/$1,000 Valuation $ $1000 per SAC Unit $ 00 $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 [ ] $ ®�- APR --"'5-02 FR I 2:25 PM DAVE'S APPLIANCE FAX NO, 612 789 8605 P. ► 0-0 N a ccx $j3 H C1 4f► 641 b� Q!1 kit (v .. o o t� V� d l7 O v cg u o o itf rn ' 0 m 4 N M 0 J%� d (a `� �O• � � I � lm SL P qd pr k111 co d o cL $� ; 0) i N -1 9x m rn ' 0 m 4 APR- 5-02 FRI 2:26 PM DAVE'S APPLIANCE FAX N0; 612 789 8605 P. 2 A. U • d -Tdiol pQIIIIMON _y_jL"TL_WC(3�V�I� -jQ8 ANS,QQM1 9 ON IA Et EMATHOM When LeM1ac1✓rta an istina fu n e. the undersigned hereby vorifios that the venting has been examined and is free from rust, deterioration, obstrvc COW, Yes { { and is securely supported and firestopped where required. NO The venting system is ptas'WPVC and meets all current codes and marrufacturer speeiflcations Including sizing, length, number or elbows and termination. Yes( No( ) The undersigned also verifies that the replacement unit is a limed assn ably ,__ Fan Assisted or Nat and meets the current codes and manufacturer's specifications. This does Fan Assisted or Nat.. Fan Assisted or Nat include AGA-GAMA Category I Central Furnace Venfing'rabies for fan _ assisted and natural draft appliances. Yes Not ) The g,xlstiog combustion air is sized and installed to memt the current tides Yes t) No ( ) and manufacturers specifications. Appliance #3 Vern Connector Height. ft Length ,_„__ _ When required to Install a new gombustion atr`it will be sized and Instaileti To meet the current codes and vianufacturees specifications. Yes () No { ) When ino 1llna a new ventio-( system, the undersigned hereby verifies that It Is a listed assembly and meets the current codes and manufacturers specificatlons. This does Induce AGA GAMA Category I Central Fumacc Yes () No ( ) Venting Tables for Ian assisted and natural draft appliances. Is the common vent and vent connectors sized and installed correcrcly after an appliance has beer►'removev from the Y-)mrnonvent and vented separately as per current codes. Yes {) No App-hancoTyfse and &1zeIC9mrnon Vent and Yttt Cor�Qr Infomna�lQn Appliance 01 Type }A�% —_ BTU Input ,r ,__ Fan Assisted or Nat Appliance 02 Type „_.. w STU Input Appliance #3 Type _______� ..�__�._. BTU Input Fan Assisted or Nat.. Fan Assisted or Nat Total Appliances ��,.., Total Biu Input _ Common Vent Type . ___.. _ _ vent Helght .....r.._..__..... Diameter.-_,— inches AppiiariGB #1 Vent Connector Height.. it Length ---.t Olameter . M jn Type Appliance #2 Vent Connector Height „^.r. H Length --ft Diameter _.._ in Type Typo Appliance #3 Vern Connector Height. ft Length ,_„__ _ R Diatrnoter _.__ _--in ALTER,�T�!�a�t.___----.---- HEATING CO: Signed BY: Z0/M'd S098682, 01 =17 AJID W02i:'j 851;eT 0002^Ta^r101r ' SUBJECT P T NO. City of Fridley32708 C" AT THE TOP OF THE TWINS BUILDING PERMIT r 16. RECEIPT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r E 1 • � NUMBED REV DATE PAGE OF APPROVED BY I 1 CITY HALL FRIDLEY 55432 "'"�� •�' 612-571-3450 910415 6/19/02 10B ADDRESS 991 67 Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 1 Michael Servetus Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Tom Svensk 991 67 Avenue NE 763-574-0837 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Renewal By Andersen 1920 Co Rd C W, Roseville, MN 55113 651-264-4777 20130983 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 O NEW ❑ ADDITION ❑ ALTERATION jD REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Replace 11 windows within existing openings 9 CHANGE OF USE FROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Permit inspection dards Will Be Mailed To Homeowner To Post 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 $6.96 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $13,924 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- $237.25 Fire SC $13.92 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE Lice a SC $5. 0 $263.13 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT iDAiEi H PR Y VA ED THIS IS YOUR PERMIT r S-GNATU'aE 0F OWNER-If OWNER BU4�DATE� B0ERi G r�AtE 'NSP NEW[ ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: q L-- 61- 9LLL — N , Legal Description: Owner Name & Address: -To vnr, SV,!x SYS ,. Tel. #_14 3.5 •O � 3 - Contractor:;MN LICENSE # dOl�9� Address: 191 a 6 CAS, n�1l O_Q ca C, l.* -E4; BSc ui tk . rt%1j Tel. # (as l • 2(04 • y Attach. to this application, a*Certificateof Survey. of -the lot, with the :proposed iconstruction-drawa on it to scale. DESCRI 1.ON'QF IMPI&00MENr LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: �kn .r, G •.c-�:.n n_ ter, n .,. Construction Type: Estimated Cost: $ l_!), 4aLi Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: jy: �, •Ua APPLICANT•AI Tel. # 9Sa •3qs•(Cdq- TOTAL STIPULATIONS: CITY USE ONLY Permit Fee $ a 3'} o1S Fee Schedule on Reverse Side Fire Surcharge $ 3 9 % .001 of Permit Valuation (1/10th%) State Surcharge $ ID 9e $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ 5 °= $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 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 r63) 572-3604 FAX: (763) 571-1287 ADDRESS : 99167 AVE NE PIN : 133024230054 LEGAL DESC : MICHAEL SERVETUS ADD : LOT 5 BLOCK 1 PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT.�00�O1198 DATE ISSUED: 07/28/2004 VALUATION : $ 1,000.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL A GAS WATER HEATER. # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0 # NEW FIXTURES (EXIST OPENINGS) # GAS DRYERS # OF NEW FIXTURES # WATER TRMT APPLIANCES APPLICANT OVERACKER TERRY PLUMBING 1630 CO RD 10 SPRING LAKE PARK, MN 55432- (763)572-8880 5 AN011- C SVENSK THOMAS G & RITA A 991 67TH AVE NE FRIDLEY, MN 55432 0 # GAS WATER HEATERS 1 0 # GAS RANGES 0 0 VALUE (FOR MINIMUM CALC) 1000 0 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 conWuction or the performance of congtruction. PLBG PERMIT MINIMUM FEE 0.00 PLBG FIXTURES (NEW OPENINGS) 0.00 PLBG FIXTURES (EXIST OPENINGS) 0.00 WATER TREATMENT APPLIANCE 0.00 WATER HEATER - ELEC 0.00 WATER HEATER - GAS 35.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 PLBG REPAIR/ALTERATIONS 0.00 STATE SURCHARGE, PLBG FLAT 0.50 TOTAL 35.50 PAID WITH CHECK # 7150 Bldg InspL Dat SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY INSPECTION DIV. e4081 Effective April 1, 2004 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT (763) 572-3604, FAX (763) 571-1287 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE TOTAL 9/ 6 7 4� /" �_ JOB ADDRESS 99/ New Fixtures $10.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $10.00 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 �/� Rain Water Leader $10.00 DATE: z , 20 ® JK Sump/Receiving Tank $10.00 Water Treating Appliance $35.00 OWNER -,) on S✓, ds Water Heater -Electric $35.00 Water Heater - Gas** / $35.00 -35-11 BUILDING USED AS Gas Range** Gas Dryer**$10.00 $10.00 ESTIMATED COST �C)00, _ PERMIT NO. Back Flow Preventer Required ( )Yes () No Type $15.00 PLUMBING COMPANY ���� ®0btA Reinspection Fee $50.00/Hr SIGNED BY TEL N0. '7 43 r P6'p'd ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance Approved By Rough -In Date Final Date State Surcharge $ .50 TOTAL FEE $T 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 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 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 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 Fum4ce 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 : CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnac , Fireplace Insert) Gas Range r Gas Dryer Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS �l �^ l rl C, C f" Fee Total Owner $35.00 $ Building Used As k ±0 1/" C- $10.00 $ ESTIMATED COST '1 0 QAC d PERMIT NO $10.00 $ $10.00 $ *Air Conditioning - All Sizes $25.00 $ All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work $ Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater.on work less than $500.00 Commercial/Industrial/Institutional 1.25% of Value of Appliance or Work (List on Back) $ Minimum Fee $35.00 for CommerciaVIndustriaVInstitutional State Surcharge $ .50 TOTAL FEE $ REINSPECTION FEE $50.00/HOUR . *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE S ii. C q S/ t DESCRIPTION OF FURNACE AND BURNER # of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name A e� L OU/ Size No. BTU HP EDR Fuel _� S Total Connected Load Burner Trade Name N S L 6 C-1 Size No. BTU HP EDR The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. e 2i�'' HEATING CW, Y J Thi'#z 3d � v/ 04PFAX # Signed 7y��_M Date Approved by Rough -in Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMM914 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 Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date : Building - --- PLUMBING PermitNo.r a Inspections RESIDENTIAL APPLICATION Received By - 763 -572-3604 Date wj: CITY OF FRY-DLE v DATE 02119/09 YOUR E-MAIL ADDRESS _ wnelson al7larsonplumbing.com SITE ADDRESS 991 67th Ave NE THIS APPLICANT IS: ❑ O'WNER MCONTRACTOR PROPERTY NAME: Thmias and Rita Svensk OWNER/ ADDRESS: 991 67th Ave NE cITY Fridley STATEMNZIP 55432 TENANT PHONE: 763-574-0837 CONTRACTOR mk%iE: Larson Plumbing, Inc. SUBMIT A COPY OF I ; ..�'T7 t icL: s� 1 3341 PM EXP DATE 12/31/2008 YOUR STATE ADL`:PEsS: 0095 - 162nd Lane NW cITY Andover sTATEMN zip 55304 LICENSE WITH Pmn ,,E 7C ;!427-7680 FAx 763/427-9448 APPLICATION _ PERMIT TYPE CK S!NGLE FAIvf11_Y ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: I 0 REPLACEMENT DETAILEI? DESCRIPTION OF VIA->' . K Water Heater Replacement PER MS 16B.665 the perl-lit r`.e is a ,uiaimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or r:.placem-,lit of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor) Labor cost under $300 cost between $300 to $500 = cost of labor x,05 = FOR PROJECTS WHERE z i :,, FEES AREAsrD �:d ;;G.u3 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH 8EL0'+h j _ BATH SINK/LAV _ IZ' B.S _ SHOWER WATER PIPING _ BATHTUSC _ - :,:> F i i� 1C ��� .^ �;rc�cEns _ SWIMMING POOL _ WATER SOFTNER ($35) _ CLOTHES AIAS14ER i` i ' _': L, d S[1 Ii; WATER CLOSET BACKFLOW PREV, ($I5) _ DISHWASHER __ 1 : -r ;a nr Y TRAY :KWATER HEATER ($35) FOR IRRIGATION _ WATER METER —OTHER Permit Fee. _. 00 Number of fixtures @ $10.00 x $10.00 = $ Surcharge _ _•,, Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE 1 Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 Total = $ - -- - -- - _ --- - _ _ 1 r.:: : • . J : J PLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED 1 hereby apply for P !'-2t U,e in,"ormation above is complete and accurate; that the work will be in conformance with the i r i:rr.. _ c., _,.• _, e; tl e. Ci,v of Frit; ..y and with the Minnesota Construction Codes; that 1 understand this is not a permit but on]y a:. ., , - : .,, rr;n it , ; d ';; o:l; i . _ ; i� start without a permit; that the work will be in accordance with the approved plan in the case ai 11 ,,`-c•s review and approval of plans. J.. SIGNATURE OF APPLICA�I' �l _PRINT NAME Amy Arvidson DATE 02/19/09 I+�il✓CIIATIC.AL MOM idley Ii ir, etions Department rsity Avenue NE, Fridley, MN 55432 '1763-572-3604 %r :2-4977 IV