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COS (2)City of Fridley SUBJECT eE:il� 491 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT `y ______ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 3/6 = � CITY HALL FRIDLEY 55432 L NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 9/13/78 JOB ADDRESS 124 st Way N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 14 2 Riverwood Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Leif Henriksen 6434 Riverview Terrace N.E. 560-4560 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 Res.identi,al 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Construct a 48' x 30' Dwelling and a 20' x 22' Garage SEPERAy�TE PERMITS REQUIRED 9 CHANGE OF USE FROM E INt0, PLUMBING AND SIGNS. STIPULATIONS Provide sod in th.efront and side yards. Provide a verifying survey before capping. Provide a hard surface. driveway. Locate house 10 feet off east lot line, 9.5' off west line. Install combustion air to the furnace. SEWER LOCATION: (Approx. 9.5' Deep In Street) 188' E. of M.H. (Inv. 844.55) WYE ELEV: 847.00 TOP OF FOOTING: 850.50 Minimum WATER LOCATION: 10' E. of Sewer Service DRIVEWAY DEPRESSION COST: Recommended by not required. C a OF DOES rNar ACCttRA� WARNING cv, ,� r*us DATA �S � UWAT�pN. Befofe digging call local utilities M -So® m U*4 OM R OS" R C04Y AM TELEPHONE - ELECTRIC - GAS Etc. aft Tft INMIt MATZO. d SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. Wood Frame 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 1344 + 440 31,280 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 $ 44,365 $22.15 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUT ITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS O NY OTHER ST OR LOCA LAW REGULATING CON- $125.12 $400.00 STRUCTION HE P F M OF CO UCTION. PLAN CHECK FEE TOTALFEE .28 $578.58 81GI1711OFCQITRACTORORAUTHORIZEDAGENT (DATE) (/ HEN PROPE LYS� V,A,LIDATEqq THIS IS YOUR PERMIT tm W -a nJ 9-1,3-28 BLDG. INSP DATE SIGNATURE OF OWNER 0F OWNER BUILDER) (DATE) a' • CITY OF FRIDLEY APPLICATION FOR RESI1 ENTIAL BUILDING PER1111 (NEW, ALTER/1Tins, ADDITIONS, OR REPAIRS) 0111NER: • Address: No. % c2 LOT: 2 � Str nulruDER: �C,I` � ��i_-,t,e� - Address: -e ca (� y ✓� Tel. No.: -" BIACK:ADDITIOP7: ; 1 COMER LOT: INSIDE LOT: SETBACK: SIDEYARDS: Applicar:t attach to this form T::o Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING j To Be Used As: _Front:Z r _ Depth: i C- Height: b Square Fedt: _ Cubic Feet: Front: —� Depth: _ � ,�:? Height: USquare Feet: Cubic Feet: Type of Construction: Estimated Cost: $ �z ali�j� To Be Completed: Alt. A Alt. B_ Fr®posed Drivc,day Width If New Opening Is Desired _4� $ $ (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 ruileangs, and hereby declares that all the facts and representations state in this application are true and correct. See reverse side f a iti info tion. DATES — 9' SIGNATURE: Stipulations: • I BUILDING PER141T FEE SCHEDULE SECTION 2. The Inspector of Buildings shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repairs to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: . NEW CONSTRUCTION: Single Family Homes and Garages: $4.00/1,000 cubic feet.. PLAN CHECK: 25 percent of building permit fee. DRIVEWAY DEPRESSION: (Concrete Curb Streets Only) Alternate A: Removal and replacement of concrete curb and gutter only; Driveway width plus 6 feet x $14.50 Alternate B: Removal and replacement of concrete curb and gutter and install a 3 foot wide approach with 6 inch depth; Driveway width plus 6 feet x $17.20 5rjoou &ArT .►v s Q "C* -r jC MMJ6�C /o ' of -F - ,W Ef.T L MO r4^ ,5 -t .22, /Cs NOTE: Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Ce--tificate of Survey of -the lot, showing the location of the foundation once it has been constructed will be required before proceeding with the framing. AAAMMAMINE U641801MIN Application for a Certificate of Occupancy shall be made ten (10) days prior to the use or occupancy of any structure for which a building permit has been issued; and said structure shall not be used or occupied until a Certificate of Occupancy has been issued. it 0 -ENF:ttGY CONSERVATION SUPPLEMENT TO BUILDING PEPMIT APPLICATION PLANNING AND INSPECTION DEPARTMENT CITY OF FRIDLEY, MINNESOTA This supplercnt is provided to assist the applicant in computing EXTERIOR ENVELOPE AVERAGE "U" FACTOR INFORMATION. This information is required so the BUILDING OFFICIAL can determine that submitted plans comply with the ENERGY CONSERVATION DESIGN CRITERIA of the STATE BUILDING CODE (Section 6000). It is the APPLICANT'S responsibility to accurately compute the data; reflect the proper DESIGN CRITERIA in the plans; submit product specifications, if needed to support the "R" and "U" factors used; and to assurp construction is per approved laps. JOB LOCATION: OWNER/CONTRACTOR: ADDRESS: A. Determine the Total Exposed Wall Area as follows: I. Total wall window area 2. Total door_ area 3. Total sliding glass door area 4. Total fireplace wall area 5. Total wall framing area (average .10%) 6. Total net wall area above floor(average 900) 7. Total rim joist area Svbtoi:aJ_: Total exposed wall area above floor 8. Total foundation window area 9. Total net foundation area above grade Subtutal: Total exposed foundation area GRAND TOTAL,EXPOSED WALL AREA PHONE :cam © V,& Wo 200.2 JCC? B. Multiply the GRAND TOTAL EXPOSED WALL AREA X .17 = C. Determine the Total Exposed Roof/Ceiling Area as follows: 10. Total skylight area 11. Total roof/ceiling framing area (10%) 12. Total net insulated roof/ceiling area GRAND TOTAL EXPOSED ROOF/CEILING AREA l 0 D. Multiply the GRAND TOTAL EXPOSED ROOF/CEILING AREA X .05 = Item I Item II 76*1 Lj E. Determine the "U" value of each segment (1-9) and multiply by the arca as follows: Item _ 11. Add X 11U91 7 X Ifull � -S2. X „U„ x fluff r 3. 3Q X foul 4. 2- x „U,$ 5. �O x foU,l 6. x fluff 7 = /� 19- 7. %0 S� x f,U„ (P - �, 30 8. X flu„ 9. ADD 1-9 FOR TOTAL'WALL SEGMENTS = ITEM III 3 0,91 /10 F. Determine the "U" value of each segment (10-12) and multiply by the area as follows: le. Add X "U" Item _ 11. Add X 11U91 7 = 12. 122 �_� X „U„ ADD 10-12 FOR TOTAL ROOF/CEILING SEGMENTS = ITEM IV TX, O G. If Item III is the same as, or less than Item I, you have met the intent of State Building Code 6006 (c) 2. H. If Item IV is the same as, or less than Item II, you have met the intent of State Building Code 6006 (c) 1. I. Add Item I + Item II = J. Add Item III + Item IV = K. If the sum of Items III and IV are less than Items I and II, you have met the intent of the Code for total envelope system. The undersigned, as applicant for a building permit; hereby affirms the above information has been prepared and submitted by himself or under his direction, hereby acknowledges the information to be correct and accurate; and hereby presents the information with required plans in support of the building permit application. By: m DATE: 8-2-3- 7g' 00 "X yd Jyya mi c3o X Lf /,r a2 q - 9� /3 V -el X ® -R2-x Z® ® 'Wo x (6 --- - - —*"A� ab z 943 ..25fv, - J 3 qq x 3; z a G 6g /) z5 �vp 3,1Pe,Gv 1406ov iL ca2�,,880) s 5A /(p V q® U MINNESOTA VALLEY*Tolospl c SURVEYORS & ENGINEERS CORP. 12006 12TH AVENUE SOUTH BURNSVfLLE, MINNESOTA 55337 Phone: 890-7750 Certificate, of Survey for : L/67 HEN�P,�kSE/V _ 715 r W,4> ' NZ Ourb - -- --- - o a 875 0 97r e DeoofJs Iraq IYJ�i��/mr�Jf 6pfoE ;j, g�6e r"ll N p®�' SON' pStiS QN��t�pt� 1*0010 Of ov!l jN, . �A V�NG S1� ,?w5c 5 ' r ©N:N r =' 30 DAY NOTICE TO CITY ENS-. jolt Guo DIV. REQUIREDEN pVa AN YR pp tlih'K- A `aRtvE�A i DT 14,.5L - �1!6� 1 hereby certify tisot this is o True and correct representation mingesuts `alley Surveyors dic of o survey of the boundaries of the above described land, Ea/!c COrp, and of the location of all buildings, thereon, and all visible lyr �% .RL S - encroachments, J any, from r on Said land s (('' As surveyed by me thn��day of _�p A.0 191 ° iflR, Ret. NO. __ rl�7 �'lU iyj X3/ e CITY OF FRIDLEY . APPLICATION FOR PWMBING AND GAS FITTING PERMIT yo m c a. � u CN ty Water Job Address c 11 7 A tft C ..4 m G u , Heater a'vA w d e Be 1 14 w Department of Buildings s, J 0S C 3 Su ,C City of Fridleyo 0 Hi lxJ U) a" ° x � � p as lec Tel. #571-3450 w a aw y w uma.. 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 1st and rulings of the Department of Buildings, and.hereby declares that all the facts and representations stated in this application are true and correct Fridley,' Mn. 4 , 19 7e' 3rd -7 4 th OWNER A 1 /i (R) - Future Connection Opening Connected with Sewer RIND OF BUILDING (F% 1-7,>/z /�� i+i M - New Fixture, Old Opening Water USED AS TO BE COMPLETED ABOUT 7�� �/ - -0 . PARTIAL RATE SCHEDULE ESTIMATED COST PLUMING FIXTURE RATES: NO. RATE TOTAL OLD - NEW BUILDING PERMIT NO. PERMIT NO. /Qo Rcaber Fixtures 6 x $3.00 $�b•UU /� Future Fixture Opening x $2.00 $ Company New Fixture, Old Opening x $2.00 $ Signed By Catch Basin x $5.00 $ Water theater - to 99,000 BTU ( x $5.00 $ Tel. No. 'moi 5���� 100,000 BTU to 199,000 BTU x $10.00 $ Water Softener x $7.00 $. . New Ground Run Old Building x $5.00 $ ROUGH INSP. ' Date Electric Water Heater x $5.00 $ GAS FITTING FEES: FINAL INSP. lst 3 fixtures x'$3.00 $ 3'VU Date Additional Fixtures x $1.00 $ . Gas .Range to 199,000 BTO x S10.00 $ APPROVAL FOR PERMIT REPAIRS & ALTERATION'S First $100.00 $5.00 $ . each add. $100.00 or fraction $2.00 $ MINIMUM FEE FOR ANY PLUMBING PERMIT I8 $7.50 p= $.SO ST11TE SOR(WARGE State Surcharge $ .50 TOTAL FEE $� REINSPECTION FEE ($10.00) CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND .AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WARM AIR: Furnace Shell & Duct Work Replacement of Furnace Repairs & Alterations -up to $500.00 Repairs & Alterations each add. $500.00 MECHANICAL WARM AIR: Furnace Shell & Duct Work to 100,000 BTU each add. 50,000 BTU Replacement of Furnace Repairs & Alterations -up to $500.00 Repairs & Alterations each add. $500.00 STEAM OR HOT WATER SYSTEM: Boiler & Lines up to 100,000 BTU each addn. 50,000 BTU Boiler only up to 100,000 BTU each addn. 50,000 BTU OIL BURNER- to 3 gal. per hour each add. 3 gal. per hour GAS BURNER- from 100,000 BTU to 199,999 BTU (over 199,999 BTU see Fee Schedule) GAS FITTING FEES: RATE $12.00 7.00 7.00 4.00 TOTAL $ S $12.00 $ 12.00 4.00 $ 4 00 7.00 $ 7.00 $ 4.00 $ $12.00 $ 4.00 $ 7.00 $ 6.00 $ $10.00 10.00 $10.00 1st 3 Fixtures x $ 3.00 Additional Fixtures x $ 1.00 Gas Range to 199,000 BTU x $10.00 AIR CONDITIONING FAN HEATING SYSTEMS see Fee Schedule VENTILATING SYSTEMS ALTERATIONS $ REPAIRS State Surcharge TOTAL FEE ROUGH INSP. wce FINAL INSP. " Date ,/� APPROVAL FOR PERMIT 1r REINSPECTION FEE (.$10.00) S S s 10.00 $ 3.00. $10.00 S S $ $ .50 09,50 MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE Job Address 124 - 71st Way N.E. Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn. December 7 , 1978 OWNER Leif Henriksen KIND OF BUILDING USED AS House TO BE COMPLETED ABOUT 60 days ESTIMATED COST $2400.00 9 OLD - NEW BUILDING PERMIT NO. PERMIT NO. . DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. _ Trade Name Bryant Size No. 036125 Capacity Sq. Ft. EDR Total Connected Load BTU 125.000 HP Kind of Fuel Nat. gas BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Company uonl_. Air randitj•, ,• Signed By 1 546-0738 V 01 SUBJECT City of Fridley 0 19006 AT THE TOP OF THE TWINS BUILDING PERM O'RE r PT NO. � COMMUNITY DEVELOPMENT DIV. r PROTt IVE INSPECTION SEC. 25671 CITY HALL FRIDLEY 55432 NUMBER REV, DATE PAGE OF APPROVED BY 612-571-3450 910 -Fl S 8/03/87 1 ,4 DC 10B ADDRESS 124• , 71iatWay 'N.E. 1 LEGAL LOT NO, BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 14 2 Riverwood Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Denny and Katie Anderson 124 - 71st Way N.E. 55432 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Aspenson Construction 291 Rice creek Terrace 55b2 574-9706 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 12 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK 16 bv 20 foot Addition to the rear of the house Family room and porch Family room - 16' by 20", deck 8' by 101, screened pordh 16' by 10" 9 CHANGE OF USE FROM TO 5 STIPULATIONS ����� 17[��a OA' rte. �"� /�8 l• SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. addition 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 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 ] Az�A �t!J 5S --40 *6---9-S- /049 - DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REG U TING CON- STRUCTI THE PERFORMANCE OF CONSTRUCTION. Q i� $ 0.00 PLAN CHECK FEE TOTAL FEE / 4 �p `� oq'24 c2Aj. eJG7 SIGNATURE OF Cq Tg Ciq TFiORIZED AGE (DATE) WHEN PR PERL VALIDATED THIS IS YOUR P RMIT SIGNATURE OF OWNER 0F OWNER BUILDERi IDATEI BLDG iNSP nATE V 01 QA. �ltj zo 49 C- -I? �020' '96 K 6 CnZ'1, 65%4 G,)O"j 1s,,s3 9(al T?l I D 1, - 0 ? "5000, 90 i,38 NEW [ ] City of Fridley Effective 4/1/86 ADDN, [ ] R-1 AND R-2 5 ALTER. [ ] Building Permit Application Construction Address: � � X�Z JVAY Legal Description: Owner Name Contractor Address Attach to this application, a Certificate of Survey of the lo/t, with the proposed construction drawn on it to scale. 7 d /J -1'0 ��f� 2 0 T H o c% -,s C ©D 1 DESCRIPTION OF IMPROVEMENT 'I Sq. Ft. LIVING AREA: GA�AGE AREA: DECK AREA: OTHER: Length � Width 26 Height Length Width Height Sq. Ft. Length Widthit — Hgt/Ground Sq. Ft. Corner Lot [ ] Inside Lot P1 Ft. Yd. Setbac Type of Construction:�11�f��ldO�i Approx. Completion Date: „� � e 7 Side and et ack Estimated Cost: $� Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: APPLICANT: Permit Fee $ Plan Check $ State Surcharge $ SAC Charge $ Park Fee $ Sewer Main Charge $ TOTAL $ STIPULATIONS: Tel. # N CITY/USE ONLY �!5%)ee Schedule on Reverse Side of Building Permit Fee $.50/$1,000 Valuation $525 per SAC Unit Fee Determined by Engineering v Agreement Necessary [ ] Not Necessary [ ] "�dl A sv ` 9 Ifo, 50 P)I,Ou or zo CITY& FRIDLEY INSPECTION DIV, Effective On January 1;1993 6431 University'Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 512-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES State Surcharge TOTAL FEE $ ,50 MINIMUM FEE FOR ANY HEATING/COOL NGNENTILATION REFRIGERATiONAIR CONDITIONING PERMIT IS 115.00 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 BTU HP HEATING Size No. EDR Signed B W Tel No. 0 � Approved By l� , / Rough—in Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE JOB ADDRESS ?1 RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner — rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 20.00 representations stated in this application are true an correct, f 'T ,1993 Gas Piping (Needed with new furnace) $10.00 $ /U• �� OWNER ,.%�. n/-) iS An C).orc o/J Gas Range $ 10.00 $ BUILDING USED ASc�ea L Gas Dryer $10.00 $ ESTIMATED COST , % 9 3,66 PERMIT NO. l4 *Air Conditioning — All Sizes $10.00 • DESCRIPTION OF EQRNACtE AND OR BURNER All Others/Repaim & Alterations (LIST ON BACK 1% of Value of Appliance or Work $ No, of Heating Units / Circle One (Steam) (Hot Water) (Warm Air) Trade Name .7— Size No.1IP AA01,026 e e Commerclal/Industrlal BTU J -J ,,oe o HP EDR 1% of Value of Appliance or Work $ Fuel Total Connected Load State Surcharge TOTAL FEE $ ,50 MINIMUM FEE FOR ANY HEATING/COOL NGNENTILATION REFRIGERATiONAIR CONDITIONING PERMIT IS 115.00 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 BTU HP HEATING Size No. EDR Signed B W Tel No. 0 � Approved By l� , / Rough—in Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Rema Arks lie 9 CSII+MY AND 8TACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: .1. Has been carefully examined Yes 2. Is free from rust or -deterioration Yes (4"**No ( ) 3. Has no foreign objects lodged within Yes (vf_�No ( ) 4. Is securely supported Yes No ( ) S. y Meets all current Code requirements for size -and total BTU's connected Yes ( No ( ) 6. Has total heating BTU's of —0- 0rAll Allother BTU's 7Z600 TOTAL BTU's ? pkv Rema Arks lie 9 List Alterations BeiAA Done: HEATING COMPANY Signed By �C Date - � 3 HOUSE TEST HEATING RECORD ADDRESS ' s� ,t -el, APT. FLOOR CITY SUBURB - f OCCUPANT �c�.-� �,'� �n(prson OWNER HEAT LOSS DATE HTG. INST. j • OWNER SOLD BY '/ ornc. /l.'n.s /fr��7•`, ,� y� /J /� INSTALLED BY Electrical Work By ' E Gas Line By TYPE OF HEAT GA FA_4 HW STEAMSP CE HTR. UNIT TR. OTHER GAS DESIGN MAKE; Model A- 1/0 od-o Serial_ INPUT CONTROLS THERMOSTAT -T87 Heat Plug Valve Limit Limit Setting Fan Settingme Pilot Type_ Pilot Make Pilot Model Pilot Timing L.W. Cut Off Pressure -3,.:;- Percent CO2 Input CFH Percent 02 Stack Temp. 3 D Percent CO CONVERSION MAKE OF BURNER Model Max. BTU Rating MAKE OF FURNACE Model Vent Size KIND OF LINER tom- C'_, SIZE NONE Draft Hood Regulator Filter Size 4 Number_ �-,r-// Chimney Location Inside Outside �- Chimney Construction �; ✓:�,� f -1,T c�/� Smoke Bomb Wiring Draft Test Tag Door Pressure Light Inst. Date Tested '91-/Cj -e/,3 Company Testing XZc6l, . & Name of Tester /_CP SUBJECT PE city of Fridley 25813 AT THE TOP OF THE TWINS BUILDING PERMIT r T NO. v _____ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r I I . i CITY HALL FRIDLEY 55432 NUMBER REV DATEPAGE OF APPROVED BY 612-571-3450 910-F15 2/19/98 JOB ADDRESS 124 71 Way NE I LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 14 2 Riverwood Manor I SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dennis Anderson 124 71 Way NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Stock Roofing Inc 289 Liberty St NE, Fridley, MN 55432 780-3561 3112 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION Ck REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (28 Sq) Tear-off 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 1 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 $1.67 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,335 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 $2.34 STRUCTION OR THE PERF ANCE OF CONSTRUCTION. \ - /_ PLAN CHECK FEE TOTAL FEE A License SC $5.00 $83.76 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI P RR�OPERLY LIDATED THIS IS YOUR 4WHEN BLAG INSP /PERMIT BATE SIGNATURE OF OWNER,1F OWNER BUILOERI IDATEI NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION S� l3 ConstructionAddress: /o2 Legal Description: Owner Name & Address: ,Qev/%is Tel. # Contractor:��o �k /<o��f i�c MN LICENSE # 3'112 Address: Tel. # 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: 0�8� �e �d �� �� s�� ���. ��4,< Construction Type: /<e- /' cc) Estimated Cost: $ a3 (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: --Z - / r" 5� -�" APPLICANT: ` � O<-- Tel. # ZY6- 3,5-6 tl Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee $ Sewer Main Charge $ TOTAL STIPULATIONS: $ '7- > > <_,3 7 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 [ ] From: 7634283682 Page: 2/2 Date: 11/15/201011:44:51 AM Building MECHANICAL Permit No. Inspections RESIDENTIAL APPLICATION Received BY: 763-572-3604 CITY OF FRIDLEY pate _ 763-502-4977 FAX EFFECTIVE 2-19-09 — ry� DATE l � 1J YOUR E-MAIL ADDRESS SITE ADDRESS 42 ( /y N E THIS APPLICANT 15. ❑ OWNER W&TRACTOR .... PROPERTY NAME:�'� N OWNER! TENANT _ _ AnnRESS: S1L1tiL�1i ' — CrrY STATE ZIP �-- — — CONTRACTOR COMPANYNAME• SUBMIT A COPY OF •_ IV CONTACT PLRSON --��.1��— - 0 _•, --—••�--- YOUR STATL• STATE LIC•LNS : H EXP DATE, _ - LICENSE WITH ADDRESS: CITY STAQMe APPLICAT[ON _ PHONE FAX PERMIT TYPE INGLE FAMILY ❑ TWO FAMLLY ❑ TOWNHOUSE TYPE OF WORK: O NEW --lip. REPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK _ FEES ARE BASED ON $10.00 PER FIXTURE,� CEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL, NUMBER OF EAC'14 SELOW) Equipment Installed MFG: " *A'—' L MODEL: 34•,5- GAS SIZEBTU _k MFG; MODEL: S12E/STU MFG: MOPEL; STZE/BTU A/C 525.00 _FIREPLACE (GAS) $15,00 —GAS RANGEIOVEN $10.00 _AIR TO AIR EXCHANGEFR $15 FIREPLACE (WOOD) 535.00 GAS GRILL $10.00 _NEW BOII,ER $35,00 /XFURNACL• $35.00 —GAS UNIT HTR $10.00 CHIMNEY LINER $10,00 _GAS DRYER $10.00 _POOL HEATER $35.00 DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00 Number of fixtures @ $10.00 x $10.00 = $ Number of fixtures @ $15.00 x $15.00:= $ Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35,00._ % _ x $35.00 = $_ _ 'S" State Surcharge = $ .50 0 0000000 INiMUM FEE $35.50 Total= 5 TFUS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSM) 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 u iderstand this is not a permit. but only an application for a permit and work is not to start without a permit; that the work will be in a=-rdance with the approved plan in the case of all work which q ' e- eview and approval of plans. SIGNATURC OFAPPLICANT ` _PRINT NA E�i rte. � DATE PLEASE NOTE: SEPARATE PERMITS -ARE RE U1RED FOR BU1L-D1N•G,,TLECTRICAL AND IvIECI3ANIC 4L w0 -RK City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 a M