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PRE 2010 DOCS• City of Fridley, Minn. • BUILDING PERMIT N® 3763 Date: .... /... ..... .�v.� ......... �,,,. Owner ....................................... Builder ...L/.�........�!�:��... Address ...................................... Address ............................................. �] �AT��QN OFB BUILDING No. . . �..... Street .. /..�... .. .... . ( ...' ' :.... Part of t ..... . . ..... .. ... ... .. . . .... Lot .... ...... Block .. a ............. on or Sub -Division ... ........ Corner Lot ............ Inside Lot ............ Setback :?. .. Sideyard Z .... . ................. DESCRIPTION OF BUILDING To be Used as: ri ... Front � D G Depth . Z f� -'Height .. I f ® Sq. Ft.10 4!P Cu. Ft. � Q�y �r4��E i � Front ��-.� 'Depth Heiyht /.MA sq. Ft. 53.(a. Cu. Ft.3340 Type of Construction ................... Est Cost... . l.. fro be Completed .................. . In consideration of the issuance to me of a permit to construct the building desribed above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. X.... ..- ................... ......... C:P-v In consideration of the payment of a fee of ........, permit is hereby granted to ................... ......................... to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it Is granted and his agents, employees and workmen, In all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. I �� NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. Application for Power Plants and Heating, Coaling, Ventilation, Refrigeration and 6 Air Conditioning Systennr and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work .......................... 8.00'-$ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 each add. 60,000 BTU ....................... 2.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations --up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace. Shell & Lines—to 400 sq. ft. IDR Steam ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. IDR Hot Water ... 8.00 $ Each add. 200 sq. ft. IDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER to 3 gal. per hour .... . ................... 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 409,000 BTU) ....................... 5.00 $ I'� GAS PIPING (Up to 3 Fixtures) .......................... 1.50 $ (Add 50c each over 3) AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS REMARKS: See Fee Schedule TOTAL FEE $ Dept. of Bldgs. Phone SII 4-7470 — 7e�, 7X -,w — . '57i�?, o IZ City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn__ Owner iCr a'r / /✓ p�F a �! 195— Kind of Building / ZS -4 !77a ee - �e y► - 195-. Used as �6 To be completed about" Estimated Cost, $ ec__31 - !L�_ Old—New. Building Permit DESCRIPTION OF WORK HEATING or POWER PLANTS Steam, Hot Water, Warm Air—No Trade Name �^ 97 �' � °- Size No Capacity Sq. Ft. E.D.R O''3® a C BTU H.P. Total Connected Load Z -,C Ol ^,� 4 Tia e� Band of Fue BURNER — Trade Name_ Size No - Capacity Sq. Ft. E.D.R- -Zr.?,V aMO • BTU H.P. By ogEjooll POsr tM-8-58 Business Phone No—" �� 7!. , *+ Form BD5 1 HEAT LOSS CALCULATIONS BUILDING DEPARTMENT ' INN. Weatherstrip %. Weatherstrips A.SConstruction No. Insulation Windows Doors Gu.ide .E Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied Yes—No I Yes—No 19 Room Length ;p,3 Width /5 Height 01 Windows and Doors—Crackaae and Area I D e I A) Avy- e I FI. I Room I Length Width Height Windows and Doors—Crackaae and Area Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Floor Cell. Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl. I Room I Length Width Height Windows and Doors—Crackage and Area No, lWidthHeight No. of Lineal ff. Area of pane I of sane lights of crack Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Floor Cell. Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI. Room I Length Width Height Windows and Doors—Crackage and Area Coef. Btu Infiltration V/ y D Glass A�f I— v Exp. wall Glass X "k e Net exp. wall��- 2.17.9YT o -e. Int wall y v X X r Floor y y x Y V. Ceil. 2- /2• V Total Btu. Int. wall � Required sq. ft. E.D.R. or sq. ins. W.A. Leader area v v V f Fl. I `diems . Room I Length /i Width _j Height T,- Windows and Doors—Crackaae and Area I Ne V FI. I Room I Length Width Height Windows and Doors—Crackaae and Area Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Floor Cell. Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl. I Room I Length Width Height Windows and Doors—Crackage and Area No, lWidthHeight No. of Lineal ff. Area of pane I of sane lights of crack Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Floor Cell. Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI. Room I Length Width Height Windows and Doors—Crackage and Area Coef. Btu Coef. Btu Infiltration X y v k %A Glass at x v Net exp. wall 2.17.9YT o -e. Exp. wall Int. wall ® �, Y y k Net exp. wall y V y V Int. wall � y v v V Floor Ne V Ceil. - vv Total Btu. av- Required sq. ft. E.D.R. or sq. ins. W.A. Leader area d FI. :gyp, Room I Length �/s�r Width .7-.y Height E!� Windows and Doors—Crackage and Area Width Height No. of Lineal ft. No. of pane of pane lights of crack 31 [A2 /:!;— j— 1'% -,% ." / tpr'— I i— . 7 -A Area sq. ft. !3, P /s `9 FI. I Room I Length Width Height Windows and Doors—Crackaae and Area Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Floor Cell. Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl. I Room I Length Width Height Windows and Doors—Crackage and Area No, lWidthHeight No. of Lineal ff. Area of pane I of sane lights of crack Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Floor Cell. Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI. Room I Length Width Height Windows and Doors—Crackage and Area Coef. Btu Infiltration V/ Glass 2 - Infiltration Exp. Exp. wall, Glass at x v Net exp. wall 2.17.9YT o -e. Jt. wall Int. wall ® �, Floor G �o V x '� q• . E.D.R. or sq. ins. WA. Leader area � FI. I Room I Length Width Height Windows and Doors—Crackaae and Area Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Floor Cell. Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl. I Room I Length Width Height Windows and Doors—Crackage and Area No, lWidthHeight No. of Lineal ff. Area of pane I of sane lights of crack Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Floor Cell. Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI. Room I Length Width Height Windows and Doors—Crackage and Area Width I Height No. of Lineal ff. Area No. of pane of pane lights of crack sq. ff. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Floor Ceil. I otai Btu. Required sq. ft. E.D.R. or sq. ins. WA. Leader area Form ODS HEAT TOSS CALCULATIONS BUILDING DEPARTMENT p Weatherstri s A.S.H.V.E. Construction No. Windows Doors Guide Reference Out. Wall Int. Wall Ceiling Roof Floor i Yes.;.-NoYes—No 19 - r FI. ®, c�� Room I Length /�.f Width 9 Height / 11 i FL I A %t Windows and Doors—Crackage and Area Width Haight rNo. of Lineal ft. Area No. of sane of sane I lights of crack sa.ft. I ' itoom 1 Lengtn wiotn meignt WindowsAd Doors—Crackage and Area '/2✓ /g� . Coef. Btu Infiltration 26 e, . i 'el/ ® 0 Glass Coef. o, ® Infiltration . Exp. wall Y/ & Y y X Net exp. wall Int. wall i3 X X X )e), Floor g( x Net exp. wall ae X y, Ceil. / 6, 112 -- ZO Total Btu. Y y X Floor Required sq. ft. E.D.R. or sq. ins. W.A. Leader area v X X I ' itoom 1 Lengtn wiotn meignt WindowsAd Doors—Crackage and Area '/2✓ /g� . . Width Height No. of Lineal ft. Area No. of pane of pane lights of crack Area ft. Z _ •® 26 e, . i 6 X x V y Coef. Btu Infiltration 3 . E Int wall Y/ --5�4 ® - Glass r , d; i3 L �e Exp. wall 3c if x b g( y X 9C Net exp. wall ae X y, Cell. / �P® Int. wall ZO y Y y X Floor y v X X Ceil. 174.r Width /2 - Height R Total Btu. Required sq. ft E.D.R. or sq. ins. W.A. Leader area / FI. Room I Length Width Height ar. Windows and Doors—Crackage and Area Width Height No. of I Lineal ft. Area No. of pane of pane lights of crack sq. ff. ired sq. ft E.D.R. or sq. ins. W.A. Leader area Insulation Kind How Applied Room I Length 13 Coef. Btu Infiltration Height No. of '/2✓ /g� . ` Glass . ° y 26 e, . Exp. wall 6 X x V y Net exp. wall ° Af 3 . E Int wall ®= X y v Floor Int. wall y X Ceil. 3c if x Floor 6 "'5,. ,Total Btu. --/® - ae X y, Cell. ired sq. ft E.D.R. or sq. ins. W.A. Leader area Insulation Kind How Applied Room I Length 13 Width and Doors—Crackage and Area Btu Height No. of Lineal ft. Area of pane lights of crack sq. ft. Z i / ® 17, ab 6-4-z�- Exp. wall Net exp. wall Windows and Doors—Crackage and Area Goet. Coef. Btu Infiltration /, ° y . e// b_ Glass Ala y 6-4-z�- Exp. wall Net exp. wall 4!? Af v K v Net exp. wall ®= N // _ Int. wall y X Cell. 3c if x Floor 6 "'5,. Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area ae X y, Cell. Room I Length Width / Height ZO Total Btu. Required sq. ft E.D.R. or sq. ins. W.A. Leader area FI.1 ,9 a — Room I Length /,3 Width /® Height R Windows and Doors—Crackage and Area Width Height No. of Lineal ft. No. of pane of pane lights of crack / a /® Area sq. ft. ° Windows and Doors—Crackage and Area Goet. Btu Infiltration y/ y . Glass ° Coef. Exp. wall y x x x �( Net exp. wall "s Int. wall ®= N ok 3e -Y Floor X y v x �4 Cell. V 6 "'5,. Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 9-e Fl. 1 /3 Room I Length Width g Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration 1,V/ -60. Glass "s Exp. wall ®= N ti X -/` Net exp. wall Z, Ll el Int wall V 'm Floor Y v x X Cell. 96 /s ZO Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area - City of Fridley Application for Plumbing and Gas i=fitting Permit Dept. of Bldgs. Phone SU 4-7 DESCRIPTION OF WORK Number, Kind and Location of Fixtures t/iv� N a = 2 S Y Z Zv, C7 WATER HTR. GAS MEC. '�' � 0��p F N Base �^C 1st 2nd 3rd 4th • Future Connection Openings Connected with New Fixture, Old Openings Sewer El Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: - NO. RATE TOTAL Number Fixtures ......................-1�_ x $1.50 $ j 6 D Future Fixture Opening ................ x 1.20 $ New Fixture OldOpening.............. x 1.00 $ Catch Basin ............................. x 3.25 $ Water Heater (Up to 200,000 BTU) ......�_ x 2.00 $ 0. 9-0 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: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn. ���- , 19— Owner 9Owners , 19 Kind of Building 19 Usedas To be completed about Estimated Cost, Old—New. Building Permit Connection Permit No . ....................................................... MAY 2 7 1959 Ko�� ll Water Sewer 11 IM -8-58 Meter Deposit Application for Power Plants and Heating. Coding, Ventilation. Refrigeration and Air Conditioning System -and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 60,000 BTU ....................... 2.00 $ _ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ..................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ GAS FITTING FEES: 1st 3 Fixtures ..................... Additional Fixtures ................ Gas Range to 200,000 BTU .......... AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS REMARKS: Dept. of Bldgs, Phone SV 4-7470 - 7'z�' 71, *0"x -" X -.- City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Mmn— 195X Owner ,p 195_ Kind of Building l! y /„d> Ine "a 195— Used as To be completed about Estimated Cost, $ Old—New. Building Permit No. - DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Wates, Warm Air—No Trade Name — Size No NO RATE TOTAL Capacity Sq. Ft. E.D.R-BTU H.P. _ x $1.50 $ Total Connected Load Kind of Fuel_IEW 7.� �. _ x .50 $ BURNER —Trade Name r � ® Size No '� _ x 2.00 BTU H.P. 4-0- 4,'e IP - Capacity Sq. Ft. E.D.R- $ See Fee Schedule TOTAL FEE { 4 Y By 11 POST IM -12-58 Business Phone No �' City of Fridley • Applicabn for Mamdftg end G= r6nIng Pamb. Deprt. of Bldg*. Phone 580-3450 DESCRIPTION OF WORN tsaj ^ 0 Number, Kind and Location of Fixtures I�.� lq N cc ji 0$ / N WATER W". GAS fLEC. Base 1st 2nd 3rd 4th _ • Future Conaoctloa Oponings I ��°` �"� * New Fixture, Old Openings Soave_ 0 Cesspool 0 PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures .............' .... x $2.00 $- g, Future Fixture Opening ........... x $1.50 $ -. New Fixture Old Opening .....:.... . x $1.50 $,__ Catch Basin .................... x $3.25 $ Water Heater (Up to 99,000 BTU) . • .. x $3.00 $ New Ground Run Old Bldg. ..... x $3.25 $ Electric Water Heater........... : $2.00 S 3AS FITTING FEES: NO. RATE TOTAL Ist 3 Fixtures x $2.00 $ Additional Fixtures ................. x $ .75 $ Gas Range to 199.000 BTU ............. x $5.00 $ City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and • hereby declares that all the tact and representations stated in this application are true and correct Fridley, Minn jo/s Owner I Kind of Building fv t Used as To be completed about Estimated Cost, $ Old—New. Building Permit No. Permit No. Signed'° By - Business Ph,(,'.e No seg I'LL'/74 � ROUGH FINAL REPAIRS & ALTERATIONS—Rotor to Code .50 State Surcharge Description ............................................. tS� TOTAL FEE $ 1 SUBJECT PERMIT City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT f R EIPT NO. • COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. 3 r / I • � NUMBER REV. DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-560-3450 910-F15 10/10/74 10B ADDRESS 21 - 70th Way N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 2 Ostman's 3rd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE R. Shoquist 21 - 70th Way N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. H. E. Berry 7099 Hickory Drive N.E., Fridley, Mn. 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 CX ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Basement Remodeling 9 CHANGE OF USE FROM TO STIPULATIONS SEPERATE PERMITS REQUIRED FOR WIRING, HEATING, PLUMBING AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood Frame THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R-1 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. $3, 000 1.50 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- $15.00 STRUC ION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE 10 A �� (�� $19.50 SI(MATUREOFCONTRACT RAUT oRIZEO ENT (DATE) W PROPERLY VALIDATED I S YOUR PEIRMIT ' BLDG )NSP DATE SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME • BUILDER:' ADDRESS: NO • . STREET: !-, 74 ' " LOT: BLOCK: ADDITION : OS i mf) o Jed /Q&8J CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: Front: Hei Depth: ht: r t Square Feet: Cubic Feet: Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: Estimated Cost: $ 3,000 — To Be Completed: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in stiict 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: fd 17 SIGNATURE: 41 - (See Reverse Side For Additional Information.) CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES �� 6 JOB ADDRESS RATE SCHEDULE The undersigned hereby makes application for a permit for the work Residential Rate TOTAL herein specified agreeing to do all work in strict accordance with the Furnace Shell and Duct Work, Burner - city codes and ruling of the Building Division, and hereby declares Also Replacement Furnace $ 20.00 $ that all the facts and representations stated in this application are true and correct. 1991 Gas Piping (Needed with new furnace) $ 10.00 $ a OWNER�o Gas Range $ 10.00 $ BUILDING USED AS Gas Dryer $ 10.00 $ t o o 1-30 ® ESTIMATED COST PERMIT NO. *Air Conditioning - All Sizes $10.00 $ DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. Commercial/Industrial BTU HP EDR 1 % of Value of Appliance or Work $ Fuel Total Connected Load State Surcharge $ .50_ Burner Trade Name Size No. BTU HP EDR TOTAL FEE s $ HEATING COMPANY Minna as;fl; 700 1F34e-5326 MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION P O Linden AYenUe REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 Signed By s PLUS THE $.50 STATE SURCHARGE apo is, MN 554.4.0.1165 REINSPECTION FEE $30.00 Approved By Roug Final Date -12- �< *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATk qco 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 SUBJECT PE City of Fridley ? 4 1 9 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. � • COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC_[ ®� r CITY HALL FRIDLEY 55432 NUMBER RE7 DATE PAGE Of APPROVED By 612-571-3450 910-F15 5/7/96 JOB ADDRESS 21 70 Way NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 2 Ostman's Third Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ronald/Geraldine Shoquist 21 70 Way NE 571-6127 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. 6 USE OF BUILDING Residential 7 CLASS OF WORK � ❑ NEW pX ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 14' x 14' Deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. Before d'gging call Aw '91,utility locatiaq RRDo02 EQUI BY LqW., 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 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 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 $1,679 $.84 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- $54.00 Fire SC $1.68 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $56.52 SIGN URE OFCONTRAC IDATEI WHEN PROPS VALIDATED THIS IS YOUR PERMIT �AlIEDAGENT N TUR O NER IIFO E BUIL RI IDATEI B G INSP DATE NEW [ ] Effective 3/1/96 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress: 7 62 fh -, mly S�SY3 -2_ Legal Description: Owner Name & Address: I,,? -12 ��' pr 2a y+ S� v a e �- Tel. # -T7/-4/,;L 10% Contractor: MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF Il"ROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length [ _ Width ��_ Hgt/Ground, b ' Sq. Ft. /5P (o Y OTHER: Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: TLQ a L O e d ar Estimated Cost: $.2SQ0 XC q, 2 Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. 6 Ft = Ft. x $ _ $ DATE: APPLICANT: Tel. # 5 7 / -G /a 7 CITY USE ONLY Permit Fee $ ��� Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ , �L� $.50/$1,000 Valuation SAC Charge $ $900 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 Dark Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ J�-(O ' Z STIPULATIONS: C. E. COULTER LAND SURVEYOR MAPPING REGISTERED UNDER LAWS OF STATE OF MINNESOTA LICENSED BY ORDINANOE OF CITY OF MINNEAPOLIS 3300 LYNDALE AVE. SO. MINNEAPOLIS 8. MINN. TAYLOR 4-0370 - SURVEY FOR MON. OSTt:AJ,: �uruep,u'� (�rrtifu�ctr I i 1 IJ ep7.4� VV 70 �.� NPLATTING FARM SURVEYS LAKESHORE JUDICIAL i y that the above is a true unci correct Mat of a survey of: I hereby certif T�iJo (2), OSTMAN'S THI:,D ADDIT1C'�,;, Anoka t -•aunty, `linnesota. Lot Six (6), floc): As surveyed by me this 15th day of October 1958 A. D. Signed �� �. - fUnnesota ,eO-Istration No. 2ji4 ..F SUBJECT PERMIT City of Fridley 24956 AT THE TOP OF THE TWINS BUILDING PERMIT i ______ COMMUNITY DEVELOPMENT DIV I PROTECTIVE INSPECTION SEC r NUMBER REV DATE PAGE OF APPROVED BY i CITY HALL FRIDLEY 55432 612-571-3450 910-F15 4/11/97 JOB ADDRESS 21 70 Way NE 1 LEGAL LOT No. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 2 Ostman's Third Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ronald Shoquist 21 70 Way NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Renewal By Anderson 350 73 Ave NE #8, Fridley MN 55432 571-7816 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20040630 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION QREPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Replace windows 9 CHANGE OF USE FROM TO STIPULATIONS Replacement bedroom windows must meet the State Egress Code. Provide smoke detectors in all sleeping areas and on each level of the dwelling to meet the State Building Code. 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 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 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 $2 185 $1.09 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT W931 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- $74.75 Fire SC $2.19 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE OTAL FEE Licens SC A.00 $83.03 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IOATEI E PA ♦ - B DG INS LY V LI ED THIS IS YO R/PERMIT i gaTE _ SIGNATURE OF OWNER IIF OWNER BUILDER_ IDATEI ITY OF FRIDLEY NEV 11 AD014 [ ] ALTER [I TEL: 612-571-1287 Mar 20.96 9:48 No.001 P.`01/.02 CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building. Permit Application ConstructionAddress: 2 1 -10*k- Effective 3/1/96 Legal Description: Owner Name & Address: (Zo N& z SNOW 15 T Tel, # Contractor. TzE Ne -A- 'V Ary omCsey MN LICENSE # Z0340630 Address: -3S(3 —1?3" AVE •SyiTEB';7(Z40U�4MN-SSA32. Tel.# s'-]1-10,16 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF MWROVEMENT LIMG AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width _ Hgt/Ground Sq. Ft. OTHER: rC'jrf S , 1•AOm� V417 -V4- Fb (-(� i rj -$e , " hll r1 pew jf� ,. NO Q�YJ2C�M s , Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Sidc Yard Setbacks Type of Construction: _ Estimated Cost: $_ Z l Approx. Completion Date: 6 • l0 -q"1. (Cost:. on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft—, _Ft x $ _ $ DATE: 4. 10 APPLICANT: 7-1 ry-N Tel.. # s54.2,8s4 Permit FCC Fire Surcharge Stale Surcharge SAC Charge ucense Surcharge Driveway Tscrow CITY USE. ONLY Fce Schedule on Reverse Side .001 of Penni( Valuation (1/10th%) . $.50/$1,000 Valuation $900 per SAC Unit $5.00 (State Licensed Residential .Contractors) Alt. "A" or Alt. "B" Above Erosion CQntrol $ X $4.50.00 Conservation Plan Rcvicw Park Fee $ X Fee Determined by Engineering. Sewer Main Charge $ X Agreement Necessary [ I Not Noccssary [ ) TOTAL $ 13. 3 STIPULATIONS: SuBJEGY - P T NO. City of Fridley 30764 AT THE TOP OF THE TWINS BUILDING PERMIT P O. � ►v ------COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. I CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED By 612-571-3450 910-F15 3/24/00 JOB ADDRESS 21 70 Way NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DEscR. 6 2 Ostman's Third Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ron Shoquist 21 70 Way NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Richard Hastings Contractor 6331 Riverview Ter NE, Fridley, MN 55432 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 574-9966 4051 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Reroof House & Garage (21 Sq) Tear-off 7 CLASS OF WORK O NEW O ADDITION 0 ALTERATION 0 REPAIR 0 MOVE 0 REMOVE B DESCRIBE WORK 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING, HEATING. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,835 $.92 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- Fire SC $1.84 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $.66.20 �� TE PLAN CHECK FEE Lice S $5.00 TOTAL E .96 SIGNATURE OF CON'RACTOR OR TNORi2ED AGENT IDATEi ENOP ALID ED IS IS OURPE IT 5�! oer000l -114 BLD 1NSo - DACE S-GNATURE OF OWNER,IF OWNER SUILDER1 iDATE NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: zl 70 7"X w A Legal Description: Owner Name & Address: go A, ,`S 7— Tel. # Contractor: MN LICENSE # Gf o S I Address: 633/ Tel.# 5-*'71(-77'ce Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: L! SQ $1000 per SAC Unit License Surcharge Construction Type: T-r=+e ,F" Estimated Cost: $ " js, Alt. "A" or Alt. "B" Above Erosion Control (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: 31Ly10 APPLICANT: Tel. # 52 V- f f6 G STIPULATIONS: CITY USE ONLY Permit Fee $ 4:;4— U Fee Schedule on Reverse Side Fire Surcharge $ /_ .001 of Permit Valuation (1/10th%) State Surcharge $ Y $.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: CI►YOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 February ll,. 2002 Ron & Gerri Shoquist 21 7e Way NE Fridley, MN 55432 Re: Final Inspection at 21 70`h Way NE Contractor: River City Sheet Metal, Inc. Dear Mr. & Mrs. Shoquist: A mechanical permit was issued on June 6, 2000, to install an air conditioner at your address. According to the 1991 Uniform Mechanical Code, a final inspection shall be conducted on the work authorized by this permit. As of this date, no inspection has been called for. The permit fee that was paid covers the inspection to make sure the work was completed according to the Code. We will keep your permit open for another 30 days and if we do not hear from you within this time to set up the inspection, we will mark the permit "no inspection called for" and take no further action. To set up the inspection or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. DJ/ls CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE 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 (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK.) 1% of Value of Appliance or Work Commercial/Industrial 1.25%u of Value of Appliance or Work Rate $ 30.00 $ 10.00 $ 10.00 $ 10.00 $ 25.00 State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Effective On January 1, 2000 JOB ADDRESS o1 I — rZ 0-11' w O -AA A � OWNER rJ at S-�- TOTAL BUILDING USED AS It: AJ G $ ry ESTIMATED COST X 3 00 - 00 PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $ Trade Name Size No. BTU HP EDR $ ,�. Q0 Fuel Total Connected Load Burner Trade Name 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 an $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE 0° j(IJA 3U . abac) River City Sheet Metal, Inc. HEATING CO 9928-13lu dSt. N.w Signed Coon Rapids, Affl_W33 99 Fax (612) 75428 Approved By 44t::�_1 Rough -In Date Final COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes( ) 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 CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 1631572-3604 FAX: (763) 571-1287 PERMITO.:2004"03' DATE ISSUED: 05/05/2004 ADDRESS : 21 70TH WAY NE PIN : 103024440044 LEGAL DESC : OSTMANS 3RD ADD : LOT 6 BLOCK 2 PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 300.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL A WATER SOFTENER. # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE # NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS # GAS DRYERS 0 # GAS RANGES # OF NEW FIXTURES 0 # WATER TRMT APPLIANCES APPLICANT SHILOAH WATER CO 7319 166 AVE NW RAMSEY, MN 55303- (763)753-9244 3JWL '_ SHOQUIST GERALDINE A 21 70TH WAY 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 worl will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. PLBG PERMIT MINIMUM FEE PLBG FIXTURES (NEW OPENINGS) PLBG FIXTURES (EXIST OPENINGS) WATER HEATER - ELEC WATER HEATER - GAS GAS RANGE FEE GAS DRYER FEE PLBG REPAIR/ALTERATIONS WATER TREATMENT APPLIANCE STATE SURCHARGE, PLBG FLAT TOTAL PAID WITH CHECK # 9837 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 0 0 0 1 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 35.00 0.50 35.50 CITY OF FRIDLEY INSPECTION DIV. Effective April 1, 2004 6431 University Ave NE O Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT l�&fo( IL (763) 572-3604, FAX (763) 571-1287 cllf MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR I PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB 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 Rain Water Leader $10.00�_ $10.00 DATE: —.20 Sump/Receiving Tank $10.00 % R Water Treating Appliance $35.00 OWNER Water Heater -Electric $35.00 PI-JeSL�C Water Heater - Gas** $35.00 BUILDING USED AS Gas Range** $10.00 ESTIMATED COST ' PERMIT NO. Gas Dryer** $10.00 max- Back Flow Preventer Required ( )Yes () No 6i�`� Type $15.00 PLUMBING COMPANY Reinspection Fee $50.00/Hr SIGNED BY �� TEL NO2L3L ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance � Approved By Rough -In Date Final Date State Surcharge $ MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST TOTAL FEE L� OF THE IMPROVEMENT 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 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 Permit No.: InspectionsRESIDENTIAL APPLICATION Received Bye' 763-572-3604 DAMP A R CITY OF FRIDLEY 1 DATE 3 S D YOUR E-MAIL ADDRESS SITE ADDRESS SawtL a�-S ©w,wt� THIS APPLICANT IS: ❑ OWNER CONTRACTOR Ronald Shoquist PROPERTY NAME: 21 70th Way OWNER/ ADDRESS: TENANT Fridley, NIN 55432 :rn PRONE: 7635716127 CONTRACTOR NAME: STATE LICENSE # 0 EXP DATE SUBMIT A COPY OF YOUR STATE //^^ ADDRESS o f e CITY i' r! /I STATE V S�fy LICENSE WITHPHONE %– y03 FAX 2 APPLICATION PERMIT TYPE SINGLE FAMILY 13 TWO FAMILY ❑ TOWN14OUSE TYPE OF WORK: ❑ NEW XREPLACEMENT DETAILED DESCRIPTION OF WORK PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00; whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This.should_reflect only.the cost of labor) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 = '•FORROJECTS WHERE LABOR EXCEEDS -$300; EES ARE BASED ON $10.00 PER FIXTURE, EXCEPT V� RE NC?TED :FIXT-0?ES,, (INDIC�ITE TOTAL ' NUMBER OF EACH BELOW) _ BATH SINK/LAV _FLOOR DRAINS _ SHOWER _ WATER PIPING —BATHTUB _ GAS PIPING (mEF.vcmarcEffm) _ SWIMMING POOL _ WATER SOFTNER ($35) _ CLOTHES WASHER _ KITCHEN SINK WATER CLOSET _ BACKFLOW PREV. ($15) _DISHWASHER -LAUNDRY TRAY TWATER DATER ($35) FOR IRRIGATION WATER METER OTHER 4 _ - � _ t Oji. � �•.. � k.:d _ , � S , 3 Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15,00 = $ Number of fixtures @ $35.00 _j x $35.00 = $ 36'.0o TOTAL DUE $ State Surcharge = $ .50 Total 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 applic . n 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 1 o w ' r uires review and approval of plans. AW�OrYI SIGNATURE OF APPLICANT5PRINT NAME Je'f' DATE 3 5 City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977