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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT NA 7069 Date: -� Owner: Builder Address Address L CATION OF BUILDING No. Street e -, Part of Lot 4 19 Lot _ __ ______ Block =- Addition or Sub -Division _ ' -� corner Lot — Inside Lot _ Setback -j_ 5— __ Sideyard — 40, Sewer Elevation sf® _Jgggaftdon Elevation 7, /oto 6 F F- ?o-ria)C. DESCRIPTION OF BUILDING T U Front Depth Height Sq. Ft. zAis Cu. Ft.L� Front Depth I--- Height AQ Sq. Ft. �Z Cu. Ft. A! - s � ev Type of Zst�ction Fast. /- `�----To be Completed • In consideration of the issuance to me of a permit to c the�buUescrirjt:ve, Iagree to do the proposed work in accordance with the description above all provisions of ordinances oP the city of Fridley. In consideration of the payment of a fee of t ✓ , 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 within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. _ NOTICE. Me permit doe not corer the construction, installation for wkbM plumbing, gas heating, "war or water. Be sun to we the Building hopeetor for separate permits for thea hams. APPLICATION FOR BUILDING PERMIT iM CITY OF, FRIDLEY,_MINNESOTA: OWNER'S NAME _--- BUILDER _ ADDRESS. ;. ADDRESS.; - LOCATION OF BUILDING No. Street ;Fart of. Lot Lot. Block/ Addition or. Subdivision Corner Lot Inside Lot x Setback Side -Yard l SEWER ELEVATION FOUNDATION ELEVATION r^,_ Applicant attach to this. form Twq Certificates of Surveyrof Lot and,proposed build- ing location drawn..on , theses Certificates . DESCRIPTION OF BUILDING To be used as: ' Froat Depth .Height Sq., Ft. Cu: ,.Ft:,.+.: Front /(o Depth Aeight „ $q.t, Cu.- Ft. Type o£.,Construction Estimated :Cost To be.Completed The undersigned herepy�makes app ication for a permit for the, work 1erein.specified, agreeing to do ill'work in strict accordance with the City of Fridley Ordinances and rulings,©f the Department of, Buildings, and hereby d, ca.ares that all;�the facts and representations stated in this application are trued correct. Schedule of Fee Costs can be found on the Reverse Side). ,40 .. 0 Y City of Fridley Application for Plumbing and Gas Ming Permit Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK Number, Kind and Location of Fixtures Location—!?/ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 $ Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin .... x 3.25 $ Water Heater (Up to 200,000 BTU) .... x 2.00 $� New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE City of Fridley: M 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 applliicatao are true and correct. /dleey,�blinn!19 AY Owner Kind of Used as To be c( Estimated Cost, $ Old Ne uilding Permit No U �' ROUGH -L--, �60 FINAL d2 By � oaC Business Phone a F N WATER HTR. GAS ELEC. 0 Base - lst 1 2nd 3rd 4th • Future Connection Openings Connected with Nen Fixture, Old Openings I sealer Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 $ Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin .... x 3.25 $ Water Heater (Up to 200,000 BTU) .... x 2.00 $� New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE City of Fridley: M 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 applliicatao are true and correct. /dleey,�blinn!19 AY Owner Kind of Used as To be c( Estimated Cost, $ Old Ne uilding Permit No U �' ROUGH -L--, �60 FINAL d2 By � oaC Business Phone • • Date: June 1, 1965 City of Fridley, Minn. BUILDING PERMIT 6J" No '7619 oma: Marlin Raae nan Builder L. W. Samuelson Const. Address 924 68th, Ave. K. Address 2AW E River Road LOCATION OF BUILDING No9� Street 68th. Ave. AI. F. Part of Lot Lot - k _ Block 2 Addition or Sub-Divisionneadowlanas, 2ld. Addition 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 FrMW Est. 1: 99100.00 _ __ To be Completed Storm Damage repair In consideration of the issuance to me of a permit to construct t bdabove I agree to do the proposed work in accordance with the description above set fortk f ance with provisions of ordinances of the city of Fridley. is In consideration of the payment of a fee ofl$0•00, permit is hereby granted to SBmtielsOn Const. 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 within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. Allen Jensen Building Impector NOTICE: Ub pwmk doss no donor the dendredden, ftwW l w for whdeg, phmbing, gas hating, sswa or wdw. So sore to sa Nn WHding lespatar for sspsnto pwndfs for thea Nems. 4 APPLICATION FOR B' ING PERMIT CITY OF FRIDLEYO #ENNESOTA OWNER'S NAM—Marlin - i! 4 BUILDERiil Samuel non e . Uk an ADDRESS _914 68th Ay�- N. JR, ADDaSO 7800 13, Ri-y-ar Rnytti LOCATION BLItDTNG No. 914 68th Ave. N. F. Street _68th Ave. N. R- Part of Lot . Lot _Block' Addit.iove or Subdvis3on 1�i..�r�rt Corner Lot Inside Lot = _SetV4tk Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form, Two Certificates of, Survey of Lot and proposed build ing location drawn ou these Cettificates. DESCRIPTION OF BtYILDING To be used as: Reaktucco - FrAMes Remaining- Paint, Decorate,etc. nWAI Iineo Front Depth Height Sq. Ft Cu. Ft, Front Depth Height Sq. Ft. Cu. Ft. Type of Construction�A Estimated Cost 98100-00 -�� S,o'mPleted A,S anc�'r.► sial �e�mi The undersigned hereby makes application for a permit for the work herein s�ecified, agreeing to do all work iit 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. .. tSchedule of Fee Costs can be found on the Reverse Side). .5 SUBJECT PER o. City of Fridley - 5 AT THE TOP OF THE TWINS BUILDING P E R M I T � ' R ___ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. It '7 Q 7 S ----,CITY HALL FRIDLEY 55432 L NUMBER REV. DATE PAGE OF APPROVED BY ----� L 612-571-3450 910-F15 9/13/79 10B ADDRESS 914 - 68th Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. . 4 2 Meadowlands 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Merlin Beseman 914 - 68th Avenue N.E. 571-4075 3 CONTRACTOR MAILADDRESS 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 j ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 14' x 18' Addition to Dwelling and Construct a 12'.x 10' Shed 8 CHANGE OF USE FROM TO STIPULATIONS NIN WARNING 8�fBet"' 6call1 .., s trwt-�i gRIC ft REQUIRej) By LAW SEPERATE PERMITS A W REQUIFfER WIRID Fp HEATING, PLUMBING iVC�, AND SIGNS, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 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 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 $7,700 $3.85 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 OR LOCAL LAW REGULATING CON- NONE STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $48.00 PLAN CHECK FEE TOTAL FEE $12.00 $63.85 SIGNATURE OF CO ACTOR0 THORIZEDAGENT (DATE) WHEN PROPERL VALIDATED THIS IS YOUR PERMIT SGNATUREOF WNERIIF OWNER BUILDERI (DATE) + BLDG INSP DAT .5 CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (New, Alterations, Additions, or Repairs) OWNER: �Y� I yI �G �' BUILDER: / / L°y;4" /-;!/ ADDRESS: ��� �� 1411' ADDRESS: TEL NO: S/�� o �i0 ZZL TEL NO: J 1-12 • Construction Location _ STREET NO: STREET:y/ O 1h /yg LOT: BLOCK: ADDITION: lAle/� Corner Lot: Inside Lot: Setback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION Front: /VDepth: � Height: �) Squane. Feet: Cubic Feet: Front: � o� r Depth: / Height: IL) I Square - Feet: Cubic Feet: ,Grp Type of Construction: Vl�� /® 1 0 ��'j��%L� Estimated Cost: Th Be Completed: ^ Alt. A Alt. B / ✓o j Proposed Driveway Width If New Opening Is Desired: $ $ SEE REVERSE SIDE OF SHEET .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 d correct. DATE: 7�_ SIGNATURE: Stipulations: ' _r" ®c SUBJECT P City of Fridleyb 17324 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY � L 612-571-3450 910-F15 11/8/83 JOB ADDRESS 914 - 68th. Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 2 1 Meadowlands 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Merlin Beseman 914 - 68th Avenue N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Richard Hastings 6331 Riverview Terrace N.E. 574-9966 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 l ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS Roof can be second layer but not 3rd. Install ridged galvanized valleys. 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 OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DV/LG. 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 VALU//��TION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1 " 475 $.74 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 OR LOCAL LAW REGULATING CON- $25.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. CHECK FEE TOTA $25.74 SIGNATURE OF CONTRACTOR OR AL^RIZED AGENT IDATEI WHEN PROPERLY VALIDATED THIS IS YOUR /PER QOT a BLDG INSP TE SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI _r" ®c CITY OF FRIDLEY . Effective Aug. 1, 1981 APPLICATIM FOR RESIDUITIAL BUILDING PERMITS (Ncm, Alterations, Additions, or Repairs) OWNER: ®�l�'��-'�+' 8_.s;tZ AAAI ,BUI.LDER: 4 of e ADDRESS: &/ X74 ,ga lrl c ADDRESS: C-.r3f a 'Z -j r--- I,,> TEL 110: TEL 110: Y i Y ' P�A-e Construction Location STRECT NO: / swmrT: ?-fA A,).. Vf if. LOT: BLOCK: 2— ADDITION: ';�_>xtb AC -1 Corner Lot: Inside Lots y Setback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTIOR OF CONSTRUCTION Front: Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet: Cubic Feet: _ Sype of Construction: PE kvc) Estimated Cost: 7b Be Cbnpleted: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SED F.F.VF.RS-7; -SIDE OF SHErT . 2be undersigned hereby makes application for a permit fcr the %:ork herein specified, agreeing to do .all work in strict accordance with the City of Fridley Ordinances and rulings of the Depirtmmt. of Buildings. and hereby declares that all the facts and representations stated in this application are true and correct. DT.TE: j ���� SIGNATUTE-. Stimulations: 110 ' CITY OF FRIDLEY INSPECTION DIV. ' 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On January 1, 1997 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT � A � d-� 5 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS New Fixtures $ 7.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $ 4.00 specified agreeing to do all work in strict acgordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $ 7.00 and representations stated in this application are true and correct. Catch Basin $ 7.00 Rain Water Leader $ 7.00 9.40A2 99ig Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Owner Water Heater —Electric $ 7.00 n! Water Heater — Gas** $10.00 Q•©© Building Used As (A) LL� /j Gas Range** $10.00 Gas Dryer** $10.00 Estimated Cost �(�� OG PERMIT NO. Back Flow Preventer Required ( )Yes () No Type $15.00 PLUMBING COMPANY Reinspection Fee $42.00/Hr SIGNED BY c TEL N0. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance ` , 16��/ Approved By Rough—In Date Final Date State Surcharge $ .50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00 TOTAL FEE 00. PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES. CINOF FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (612) 571-3450 - FAX (612) 571-1287 September 25, 2000 Diane Couillard 914 68 Ave. NE Fridley, MN 55432 Re: Final Inspection 914 68 Ave. NE Contractor: Tschida Brothers Plumbing Dear Ms. Couillard: A plumbing permit was issued on May 26, 1998, for the above noted address, to install a gas water heater. According to section 4715.2800 of the State Plumbing Code, a final inspection shall be conducted on the plumbing authorized by this permit. As of this date no inspection has been called for. You will be given thirty (30) days from receipt of this notice to respond. If we do not hear from you, we will expire the permit and any inspections on this installation will require a new permit. Any questions can be addressed to myself at (763) 572-3603. Sincerely, DAVEJENSEN Building Inspector SUBJECT PERMIT NO. City of Fridley 2 7 4 0 6 AT THE TOP OF THE TWINS BUILDING PERMIT r IPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 01.0 1 NUMBER REV DATE PAGE OF APPROVED BY = /��•1 CITY HALL FRIDLEY 55432 ti.__.Jl.' �•� 612-571-3450 910-F15 18/26/98 JOB ADDRESS 914 68th Avenue NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 4 2 Meadowlands 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dan Couillard972-0244 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. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Reroof house and garage (22 S Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING, HEATING. VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 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 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE IGNATURE OF CONTRACTOR ORAUNQR1ZED4fGPNT IDATEI LIDATED I$ I$ YDUR RMSIGNATUREOF WNROP D/L E OWNERIIF OWNERBUILDERI NEW" �[ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION P ,1,0(� -�i ConstructionAddress: y G �- )9 y4 Legal Description: ';(Owner Name & Address:Com; f ac4 91Y C�FS19v. (0 �— Tel. # S7oZ' oa`f t( x Contractor: Address: pwhpV'1- MN LICENSE # 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 GARAGE AREA: Length Width Height DECK AREA: Length Width Hgt/Ground X OTHER: Construction Type: Tel. # Sq. Ft. Sq. Ft. Sq. Ft. QQ �1ioT O,(` �045� w•'�/Y CnPn riU%��/'� a� 'SGJ �^u'— +-r-al ^044 Driveway Curb Cut Width Needed: Ft. + 6 Ft = f Estimated Cost: (Fee Schedule on Back) Ft x $ = $ x DATE: J6 APPLICANT:.. �, ,� co'- I u J Tel. # 5 7 2- o a 4 `f Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $SZ� $ 1,83 $ 0.2 - 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.: 2005-00017 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 01/05/2005 3U4 VAX: (70J) ,071-IZ57 ADDRESS 914 68 AVE NE PIN 143024140091 LEGAL DESC MEADOWLANDS 2ND ADD LOT 4 BLOCK 2 PERMIT TYPE ELECTRICAL PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADDITION/ALTERATION VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE.PH:763-757-6202 # INSPECTIONS 1 APPLICANT CENTERPOINTE ENERGY MINNEGASCO 13562 CENTRAL AVE NE BLAINE, MN 55304- (763)757-6202 OWNER COUILLARD DANIEL F & MARIE C 914 68TH 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 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 construction or the performance of construction. Applicant Date Bldg Insp Date STATE SURCHARGE, ELEC FLAT 0.50 ELEC PERMIT FEE - MIN (RESI) 20.00 TOTAL 20.50 PAID WITH CHECK # 6338 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. - CITY OF FRIDLEY PERMIT NO.: 2005-00018 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 01/05/2005 (763) 572-3604 FAX: (763) 571-1287 ADDRESS 914 68 AVE NE PIN 143024140091 LEGAL DESC MEADOWLANDS 2ND ADD LOT 4 BLOCK 2 PERMIT TYPE HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. # A/C UNITS 0 VALUE OF APPL OR WORK 0 # FURNACES 1 # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALC) 3000 APPLICANT HEATING PERMIT MINIMUM FEE FURNACE SHELL/DUCT WORK 0.00 35.00 CENTERPOINT ENERGY/MINNEGASCO 13562 CENTRAL AVE NE GAS RANGE FEE 0.00 BRANCH 1111 LOUISIAN GAS DRYER FEE 0.00 ANOKA, MN 55304- AIR CONDITIONING FEE 0.00 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 6338 0.50 35.50 OWNER COUILLARD DANIEL F & MARIE C 914 68TH 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 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 ofan other state or local law regulating construction or the pert n e o construction. Applicant Date Bldg Insp Date so4 24 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. IT *Air Conditioners can not be placed in side yard without written approval �+ from adjoining property owner - copy to City N df FILL OUT BACKSIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved by Rough4n Date Final Date ^ITY OF FRIDLEY BUILDING INSPECTION Effective 4/1/2004 v 9 3431 University Ave NE ^ 9 =ridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION L 763-5723604 FAX 763-571-1287 REFRIGERATION AND AIR CONDITiONiNG SYSTEMS AND DEVICES 9 ` D JOB ADDRESS n RATE SCHEDULE Fie_ Tota r� ` �ou l a �� Residential Owner ,e Furnace Shell and Duct Work, Burner & 3S Q also Replacement Furnace $35.00 $ Building Used As Gas Piping (New Furnace, Fireplace, Insert) $10-00 $ ESTIMATED COST 31000 • CD O PERMIT NO 2 _( 1 Gas Range $10.00 $ DESCRIPTION OF FURNACE AND BURNER Gas Dryer $10.00 $ # of Heating Units_ Circle One (Steam) (Hot Wate (Warm Air) Trade Nam Ce'r- r ; e 1, Size No. *Air Conditioning -Ail Sizes $25.00 $ BTU ko0i 000 HP EDR Fuel k,3" r cep( T;�s Total Connected Load All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work $ Burner Trade Name Size No. A Minimum Fee $15.00 for Residential or 5% of cost of BTU HP EDR Y improvement whichever is greater on work less than $300.00 The undersigned hereby makes application for a permit for the work herein z, Commercial/industrial/Institutional specified agreeing to do all work in strict accordance with the City Codes r 1.25% of Value of Appliance or Work (List on Back) $ and rulings of the Building Division, and hereby declares that all the facts Minimum Fee $35.00 for Commercial/industriai/institutionai and representations stated in this application are true and correct. CENTERPOINT ENERGY ; r State Surcharge .50 HEATING CO 13562 CENTRAL AVE NE BLAINE, MN 55304 1-. TOTAL FEE $ 3!S, so Signed Tel # 763-757-6202 v v 2-Z� REINSPECTION FEE $50.00/HOUR FAX # 763-757-6701 Date IT *Air Conditioners can not be placed in side yard without written approval �+ from adjoining property owner - copy to City N df FILL OUT BACKSIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved by Rough4n Date Final Date 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 ft Length specifications including sizing, length, number of elbows and termination. Yes (10 No( ) The undersigned also verifies that the replacement unit is a listed assembly ft Length and meets the current codes and manufacturers specifications. This does Type include AGA-GAMA Category I Central Furnace Venting Tables for fan ft Length assisted and natural draft appliances. Yes ( No( ) The existing combustion air is sized and installed to meet the current codes Ce 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 -LAMA 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 i�w rov-og c,-- BTU input X04"' Fan Assisted or Nat 1,4 Appliance #2 Type Aat&f BTU Input Ov v Fan Assisted or Nat erg Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type ('/ —�3Vent Height /L Diameter S 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° A��7f1l Ce a j(Describe) � /1Adr doe CENTERPOINT ENERGY HEATING CO: 13562 CENTRAL AVE NE BLAINE, MN 55304 Signed By: ®0K, 1AAQ9, ° _Date kZ_ ?x' 09 PPIP A TVVICVSL Dl A91G I NA AO AI T O WON -1 C;P : T T b00Z—LF—?add - NEW [ ] ADDN [ ] ALTER Construction Address: q I Q. CITY OF FRIDLEY 6431 University Ave NE, Fridley, MN 55432 SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Effective 1/1/2003 (763) 572-3604 Bldg Insp (763) 571-1287 Fax Legal Description: Owner Name & Address:JLxn i- n' Cow'I Iav-d Tel. Contractor: RICKS ROOFING & SIDING MN LICENSE # Address: X956 C-1 EVE1 AND AVE SW W. Tel. # 1 NEW BRIGHTON, MN 55112 651ft this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: Length GARAGE AREA: DECK AREA: A914.1 DESCRIPTION OF IMPROVEMENT hJr, Ri7 Length Width Length Width Height Sq. Ft. Height Sq. Ft. Hgt/Ground Sq. Ft. Construction Type: -4 F�Estimated Cost: $ � � bD Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: �� APPLICANT:&JA A�Fklia� Tel. # Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge CITY USE ONLY - TOTAL $ rl 91Z— Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1275 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 [ J