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PRE 2010 DOCSCit of Fridley City y SUBJECT ®M1423� AT THE TOP OF THE TWINS U I L D I N G P E R T r t ` g RECEIP 1 COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. N�0 -9"�/* 1 � � CITY HALL FRIDLEY 55432 IL L---- A.If %j c� / iin NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 7/26/77 JOB ADDRESS 1591 - 73k Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 4 1 DeLeier Addition SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Henry P. Korman Builder 707 Columbia Boulevard 788-7362 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 ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 42' x 26' Dwelling and a 23' x 24' Garage SEPERATE PERMITS RE0111 FID FM MRING, 9 CHANGE OF USE FROM HEATING. PLU"Mri XND SIGNS. STIPULATIONS Provide a hard surface driveway. Provide sod in the front and side yards. Provide a verifying survey before capping. Provide copy of truss design. Contract City Engineering Dept. to obtain proposed street grade data. Submit copy of energy calculations. NO UTILITY ASBUILTS AVAILABLE AT THIS TIME. WARINNG Before a E� W1 QTY -OF F DOES NOT GUARANTEE NE - ELECTRIC -'al TELEPHONE - ELE ACCU"CV OF tJi N U)CA'"ONS AND REVATION6e By LAW THIS DATA IS MR INioRMATON FURPO Us ONLY AN.) REQUIRED PERSONS USING IT Smo%D VER" THE INFORMATION ON THE SITE SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. Wood Brame 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 1134 + 552 27,864 Tot ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT 1 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 $34,630 $17.32 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- STRUCTI OR THE PERFORMANCE OF CONSTRUCTION. $111.46 $375.00 A PLAN CHECK FEE TOTALFEE X •' /UL ' . 86 $531.64 MGNATURCd1NT"&aNOR AUTHORIZED AGENT (DATr HEN PROP LY VALIDATED THIS IS YOUR PERMIT BLDG INSP '7-2)(o '97 DATE SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) OWNER Address: rITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) C� " BUILDER:�� Address:. 71Z 41-6 'IJ L6 '11' 01141 Tel. No . No.Street: l A iJ- LOT: BLACK: ADDITION: CORNER LOT: INSIDE IAT: SETBACK: SIDEYARDS: —42 10_ Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To a Used As: Front: L— Depth: Square Feet: C — Front: �3 Depth: Z� Height: bic Feet. 2 Z� '? V Square Feet. Jyidc�— Cubic Feet: Type of Construction:�,� To Be Completed: Height: 01 0 ffl'J*— 4c> Estimated Cost: $ 3 � 6.1 Alt. A Alt. B 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 trAi� and correct. See reverse side for additional information. SIGNATURE: S i ulations : p D 331, e,41 CITY OF, FRIDLEY 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432 Mr. & Mrs. Donal Lei 519 -3rd Avenue Nt�l ;l New Brighton, 'PIN 55112 Shallow Sewer Service Mr. & Mrs. Donald Leier: TELEPHONE April 29, 1977 (612)571.3450 During the process of final design for the above referenced utility project, ninimum depth of sanitary sewer was unavoidable due to existing elevations of existing sei�.ers in the area, therefore, please be advised that prior to any full basement type construction of residential buildings, it would be advisable that contact be made with the Engineering Department to determine the elevation of the sewer available for your particular future lot. The design of the sewer will be approximately 8' below the proposed street elevation. If you have any specific questions as they pertain to your lot, please feel free to contact me. Sincerely, CITY OF FRIDLEY homas A. Colbert, P.E. Assistant City Engineer TAC/ygrs cc: JUmmunity Development Darrel Clark Administrator( z o zp L SIX) %to 5533; rwz 3- Certificate of Survey for Doj L G I 'irk 42 NORTH -72-25- IL o o� Q-1 110 -72.25- 73' 4VEAVE o' Denotes iron monument ~r 4 r73-- 1 Denotes Drinae of L CaCK N A' �f ANOkIA COUNTY I hereby vo,61y that this is a t,w* and correct ropresitntation of a surway of the boun'dorigs of eh* above d*&tritx*qd land, and of the losatioro of all bvildi a thoro*7, 0041 011visible ancroac%mentsa if any, from or OR so id land As surveyed by mo this day 00 1 A 0. 9_7� it -P -bull -b -AN INGINSIMING, INC. t )O OT/L,T-Y ,60 L7-9 /v V* _.._......_ - _ — rollv LUM13ERMATE COMPANY SAINT LOYif. MFRlO Topc ttR i �0 LWisER RliG7FFCAT T _---- _ T T i } > ' C 10 Ter acaso 6' HfiQLTG F LHS ^ -� .1250 • _ _ D- FCR USE ST TRE . -.H OS O OSUSCE�SiSIEtLtTYIIT 82S ING ARCHITECT AND EnSmEER 1`I PPEPA9A-ICY OF THE711 P1RR1 .00TTor CMOwO OSAO ►s► wT>raae awwo 2X - 6 DOUG FIR 62 1250 DMS G•ISSI A--',010 82S H OSO FCR THE ERECTWK BRACING. AND ASSEMBLY TO THE CC'rFLETE STRUCTufE. 1 TOTAL oa•ICN LOA* i 60 Ps► wale 2x 4 DOUG FIR 03800 THE T SS PLATE ASEDD�MDSTE I TSE 4 is 6OO DINSTITUTEI TAWS carTaas 2-00m - NLIITID.YABy : ASSOC1AYiO6 e� @Tata* wrsaFs ercicwsa " H 5 REPETITIVE MEMBER RENDING STRESS USED I N THIS ......... _ DESIGN to MEMBERS ERrPAA E T TOSS PLATES OF SA1VEy1ZEO STEELF1O1, --_ PUTae 1S'G nwTe aaw.as 680 _. ...____..._ --- Ta Wm—mw -80.. _ . awaa t%� 18,ZO . �wTFMa _..-......-__-._...-....__.._..................... GATED ®T CAGE AN SIZE. PRESS PLATES SECUMT 0!1 50711 49 45 37'' ;h: dwep ✓Tte /%1�� €SIDES OF JgtF1TS CENTER PLATES 011 lDIRiT3 tilglS3 MOTEO _ ...t-- ---�-- PI POINT LOAINI Rl: 1400 atutL IORGp CHa —6663 -_ .. . __............_ _ _ _... AE= 350 C2= -4428 AlAI I Al• 584 D1s $6389 Al sI 117 D2m +638* f Cz HEa +117 A0 W2e —2101 W3= 42217 11Ct L- ft'<D Rt .Cial 0 cy's 1209 % 4�z P •• to T qr ISTERED • cc �I;I • ENZI;.'EEit ; t % PE. x 3199 = @ 165+c {Z .A o . A, 12 41 OF M cNN , 4�4 F 1 85, 634- SYM t 1 a - _ 24-0" 4 EQUAL PANELS coWT. LAT. aRACI Rcao ma 34 a At 0 CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Job Address 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 OWNER KIND C Fridley, Mn. _-4o 3 , 19 77 USED AS TO BE COMPLETED ABOUT >. m ESTIMATED COST U PLUMBING FIXTURE RATES: 4 • 0 TOTAL Water Number Fixtures x to $ , 0 0 ed a b a Ll o V w w $2.00 $ Heater ad 0 Signed By f�j,1:., 10_ oI14 Catch Basin x w $ a m m m $fJ Tel. No. 100,000 BTU to 199,000 BTU o $10.00 $ a ro •u $7.00 g ro� 0 New Ground Run Old Building V 9 $ as lee to u a m ci m S o w m w u w 9 9 O FINAL INSP. lat 3 fixtures x.0 ' $3.00 $ 3i�(� Date Additional Fixtures x $1.00 $ �1 Gas Range to 199,000 BTU x $10.00 $ APPROVAL FOR PERMIT 1st 2nd 3rd 4th (F.) - Future Connection Opening Connected with Sewer (*) - New Fixture, Old Opening Water Job Address 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 OWNER KIND C Fridley, Mn. _-4o 3 , 19 77 USED AS REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE $ qj REINSPECTION FEE ($10.00) MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SORaW= TO BE COMPLETED ABOUT PARTIAL RATE SCHEDULE ESTIMATED COST PLUMBING FIXTURE RATES: NO. RATE TOTAL /7 OLD(NEW UILDING PERMIT NO. PERMIT NO. 1 �� Number Fixtures x $3.00 $ , 0 0 Future Fixture Opening _ x $2.00 $e 0.0 � Company New Fixture, Old Opening x $2.00 $ ad 0 Signed By f�j,1:., 10_ oI14 Catch Basin x $5.00 $ Water Heater - to 99,000 BTU x $5.00 $fJ Tel. No. 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. Electric Water Heater x $5.00 $ Date GAS FITTING FEES: FINAL INSP. lat 3 fixtures x.0 ' $3.00 $ 3i�(� Date Additional Fixtures x $1.00 $ �1 Gas Range to 199,000 BTU x $10.00 $ APPROVAL FOR PERMIT REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE $ qj REINSPECTION FEE ($10.00) MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SORaW= CITY OF FRIDLEY • APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND $ .AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE $ 7.00 $ 4.00 $ GRAVITY WARM AIR: RATE TOTAL Job Address Furnace Shell & Duct Work $12.00 $ Replacement of Furnace Repairs & Alterations -up to $500.00 7.00 7.00 $ $ Department of Buildings Repairs & Alterations each add. $500.00 4.00 $ City of Fridley Tel. #571-3450 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: $12.00 VIX $12.00 $ 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. REINSPECTION FEE Date �a ($10.00) FINAL INSP. ,7 - ;Z V '? O Date APPROVAL FOR PERMIT S S MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE 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. r*r� KIND OF BUILDING USED AS TO BE COMPLETED ABOUT ESTIMATED ,COST OLD _ NE'W PUILDING PERMIT NO. PERMIT NO. DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Bot Water, rm Ai - No. Trade Name �,G Size No.��'0�® Capacity >Sq. Ft. EDR /®�®BTU HP Total Connected Load / Kind of Fuel .1//ff��IO . 4 n BURNER - Trade NameSize No. ��Qb Capacity Sq. Ft. EDR `BTU BP Company _RAY N. WELTER HEATING CO. Signed By 4637 Chicago Ave. mneapo ls, Minnesota Tel. No. 97-81,-L16o51• CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FINING PERMIT PARTIAL RATE'SCHEDULE PLUMBING FIXTURE RATES:. NO. ba TOTAL Itmber Fixtures x $3.00 $ F'�ture Fixture Opening x a $ Water x $2.00 $ 8 x $5.00 � 44 A O q ro 14 a F. S Water Softener Heater ai t M New Ground run old Building x $5.00 $ Electric Water Heater R 3 $ U O a 6 1st 3 fixtures x Additional Fixtures x $1.00 $ Gas Range to 199,000 BTU .�i $10.00 A C g �.�t 4 4j $5,00 M ani 8 $ m $ .50 3 $ 10.50 U w a U ro U O [aslec ani uo. vii 1st r n 2nd 3rd 4th (R) - Future Connection Opening Connected with Sewer M - New Fixture, old Opening Water PARTIAL RATE'SCHEDULE PLUMBING FIXTURE RATES:. NO. RATE TOTAL Itmber Fixtures x $3.00 $ F'�ture Fixture Opening x $2.00 $ New Fixtire, Old Opening x $2.00 $ Catch Basin x $5.00 $ Water Heater - to 99,000 BTU x $5.00 $ 100,000 BTU to 199,000 BTU x $10.00 S Water Softener x $7.00 $ New Ground run old Building x $5.00 $ Electric Water Heater x $5.00 $ GAS FITTING FEES: 1st 3 fixtures x Additional Fixtures x $1.00 $ Gas Range to 199,000 BTU x $10.00 $ REPAIRS $ ALTERATIONS First $100.00 $5,00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE $ 10.50 Job Address 17591 732 A Ve. RTE Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. 5-23-78 19 OWNER KORMAk KIND OF BUILDING frame USED AS res, TO BE COMPLETED ABOUT 5-30-78 ESTIMATED COST 20.00 OLD - NEW BUILDING PERMIT NO. PERMIT NO. /X Company l ce- 6r'w-� Signed By MINNEGASC® Tel. No. ROUGH INSP. Date FINAL INSP. Date APPROVXT FOR PERMIT -�/ MINIMUM FEE FOR ANY PLUMBING PERMIT I3 $7.50 PLUS $.SO STATE SQRCMM= -- , - v; 1 ..n JI—LI APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND .AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WARM AIR: Furnace Shell s Duct Work Replacement of Furnace Repairs & Alterations -up to $500.00 Repairs s 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 EATER SYSTBI: 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 $ S S S $12.00 S 4.00 S 7.00 $ 7.00 $ 4.00 $ TOTAL $12.00 $ 4.00 $ 7.00 S 6.00 $ $10.00 $ 10.00 $ $10.00 S S lst 3 Fixtures x $ 3.00 Additional Fixtures X $ 1.00 Gas Range to 199,000 BTU u $10.00 AIR CONDITIONING FAN HEATING SYSTEMS Sea Fee Schedule VENTILATING SYSTEMS ALTERATIONS $ REPAIRS State Surcharge TOTAL FEE ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT REINSPECTION FEE ($10.00) S S AA $L S S S $ .50 s. MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURaA = Job Address 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. 7C - 19/G p OWNERvt" KIND OF BUILDING�� USED AS TO -BE COMPLETED ABOUT �/ �DO� 7 ESTIMATED COST OL - NEW BUILDING PERMIT 110. PERMIT NO. DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Trade Name Capacity _ Sq. Ft. EDR Size No. BTU HP Total Connected Load Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Company FRANK'S HEATING AND AIR•CONnIT10NING INC. 3107 CALIFORNIA STREE NORTH EAST Signed ByP L MI 55418 TELA, 1 -SE Tel. No. ,N00, IM CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 RATE SCHEDULE Effective On January 1, 1997 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING -SYSTEMS AND DEVICES A , JOB ADDRESS1Sq I __1 31/ Z NM �Ip_ 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 $30.00 $ representations stated in this application are true and correct. (Side Vent - Fill Out Back) IFE�D"& �' 1A Gas Piping (Needed with new furnace) $10.00 $ OWNER • o W,&At�Nv �1 n� L� Gas Range $10.00 $ BUILDING USED AS lJ l/1 Gas Dryer $10.00 $ . ESTIMATED COST PERMIT N0. �� 4 *Air Conditioning - All Sizes $ 25.00 $ 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) 6G�') Trae Name—Size No.'�,R SCS (kU d 3(0 ®-1 0 Com mercialA ndustrial BTU t.2 O-C'O HP EDR 1.25% of Value of Appliance or Work $ Fuel Total Connected Load �?» State Surcharge .50 Burner Trade Name Size No. TOTAL FEE BTU HP EDR . BLAINE HTG. A/C ELECT., INC. 13562 CENTRAL AVE. N.E. HEATING CO PAN) ANOItA MN 55304 MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 Signed el No.� PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00JHr Approved By Rough -In Date Final Date I-/ - 7-41 . *Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE r4 STACK VERIFICATION ON written permission from adjoining property owner. REPLACEMENT FURNACE Remarks: . List ALTERATIONS Being Done: HEATING CO: Signed By: Date: ELAINE HTG. A/C ELECT., INC. CEOWW Y AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or suck: 1. . Has been.carefully examined Yes (X) -No O _ 2. Is free from rust or deterioration Yes (`%1 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 L (-e All other BTU's L4 0) lYl7-V TOTAL BTU's 10u I 0-c�o ' 7. Has a liner been provided for water heater Yes ( No { ). 8. Has combustion air been provided for water heater Yes (I-) No ( ) Remarks: . List ALTERATIONS Being Done: HEATING CO: Signed By: Date: ELAINE HTG. A/C ELECT., INC. --ITY OF FRIDLEY INSPECTION DIV. 3431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTIIRFS TO RF INGTAI I Fn r)N FAr_I-1 rl nr)R Effective On Jan 1, 2000 PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** NO. RATE TOTAL . JOB ADDRESS -'241VIE i"s &401EEIZ Gas Range** Gas Dryer** Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge 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 Stuilding Division, and hereby declares that all the facts .and representations stated in this aDDlication are true and correct. HOTVEDT-IACONO, NORMA 1591 73RD 1/2 AVENUE 20 FRIDLEY, MN 55432 05 (763) 780-6016 Owner _ Building Used Asl�rvlD�� CeC. Estimated Cost PERMIT NO. 13 PLUMBING COMPANY A1� SIGNED BY TEL NO.I�Z"��I''� Approved By Rough -In Date Final Date .50 J TOTAL FEE $20 --so PLUS THE $.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE 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 ail current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes O 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_ Appliance #2 Type _ Appliance #3 Type _ Total Appliances _ BTU Input _ BTU Input _ BTU Input Total Btu Input Fan Assisted or Nat Fan Assisted or Nat Fan Assisted or Nat 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 : 3uilding $ ,) ,3 I; j See Back Page for Fee Schedule BUILDING $ Permit No.: - nspections $ (21 RESIDENTIAL APPLICATION $ o Received By: r63-572-3604 $ _ oo $5.00 (State Licensed Residential Contractors) CITY OF FRIDLEY $ Date Rec'd: l% /3- >A $ YOUR E-MAIL ADDRESS Erosion Control ITE ADDRE $450 Conservation Plan Review -Eh d I , 5 $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) -IIS APPLICANT IS: O OWNER ONTRACT PROPERTY OWNER/ NAME: 0 �- ADDRESS: L) C CITY 1(i f 'e STATE IP, TENANT PHONE: CONTRACTOR NAS: er STATE LICENSE # °�IT EXP DATE I/ SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: e 1r. CITY '�' 7�t I E IP IS— WITH APPLICATION PHONE -& WO 0 FAX PROPERTY TYPE O SINGLE F Y/NEW CONSTRUCTION SIZE O TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE 0 ADDITION O GARAGEISHED [I WINDOWS 0 BASEMENT FINISH 0 ROOF 0 DRAIN TILE 0 DECK SIDING 0 OTHER 0 SWIM]VffNG POOL TYPE OF WORK- 0 NEW 0 ADDITION 0 MAIN7ITNANC&?XPAIR REMODELING DESCRIBE WORK BEING DONE: i ( f S (A 1,112L /C '22-IMAd W I CQ SIZE OF IMPROVEMENT LENGTH TH HEIGHT Sq. Ft. ROOFING 0 HOUSE ONLY NUMBER OF SQUARES 0 HOUSE & GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan G G 0 ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: 0 DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SMING FOR NEW CONSTRUCTION INCLUDING DECKS, 0 Vinyl OSoffit ADDITIONS & PORCHES SUBMIT: Aluminwn O Trim O Fascia 1. Site PlantSurvey showing the existing structures and proposed project Other i��1� 2. Two sets of construction plans WISiDI)WS 3. Energy Calculations IN EXISTING OPENINGS OYes ONo LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 V.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 5 00, OV OCCUPANCY TYPE Permit Fee $ ,) ,3 I; j See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ (21 .001 times the total job valuation Surcharge $ o .0005 x Permit Valuation Minimum $.50 License Surcharge $ _ oo $5.00 (State Licensed Residential Contractors) SAC Charge $ $1550 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21= $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ Make checks payable to: City of Fridley Attach Sti ulations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work whic uires review Sapp 1 of plans. f� DATE SIGNATURE OF APPLICANT PRINT N 3uilding $ BUILDING See Back Page for Fee Schedule Permit No.:. (,--o 1 C)' Inspections RESIDENTIAL APPLICATION Fire Surcharge Received By: 763-572-3604CITY .001 times the total job valuation OF FRIDLEY $ Date Rec'd: r q �'9 )ATE YOUR E-MAIL ADDRESS $ ;ITE ADDRESS $5.00 (State Licensed Residential Contractors) SAC Charge $ $1550 per SAC Unit (Plans to MWCC for determination) HIS APPLICANT IS: ❑ OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: lVoovap 04 4gt'n'o $ ADDRESS: /cal "" ,A� 4a e CITY ` ej�STATE ZIP TENANT $ PHONE: 70 - 70 ` 6 D 1 Ce Fee Determined by Engineering CONTRACTOR NAME: e 0` vt ea/ 611,17,_11h STATE LICENSE # o?d �J yO �� EXP DATE - 31 ` 07 SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: -27-90 _CITY Oe -l)_ c STATE ZIP WITH APPLICATION PHONE Z4y - 4113 • f Q FAX 4 -p— ePROPERTY PROPERTYTYPE OtSINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING WTHER ❑ SWIIAMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION WMAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: & cr �� P s, i�% c 6,9 d` -AK el kle A C d \5- SIZE OF IMPROVEMENT LENG WIDTH HEIGHT Sq. Ft. ROOFING &HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE I. 2. Existing Floor Plan Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim I. Site Plan/Survey showing the existing structures EkOther ffd Jri ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS r 3. Energy Calculations IN EXISTING OPENINGS JRYes ❑No LOCATION OF W WS I.I� 1 I ` 1 OR FOR NEW OPENINGS -DESCRIBE SIZE OF m a uQ OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF 1NDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THFJ997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ L090 " OCCUPANCY TYPE Permit Fee $ % See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ Gx) .0005 x Permit Valuation Minimum $.50 License Surcharge $ -ems $5.00 (State Licensed Residential Contractors) SAC Charge $ $1550 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21= $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ y CY ,a2 Make checks payable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans. J/'d'/ ®� / - r lIel /I C/ - DATE ? SIGNATURE OF APPLICANT PRINT NAME /7 ld November 4, 2006 Norma Hotvedt-Iacono, Homeowner 1591 73rd -1l2 Avenue Fridley, MN 55432 RELEASE Verner Finishes, Inc. 2730 222nd Lane NE Cedar, MN 55011 Verner Finishes Inc. accepts the final payment in the amount of $2,700.00. Contractor only accepts reduced payment as a last effort to avoid taking homeowner to court.. Verner Finishes, Inc. releases homeowner from all obligations to Verner Finishes Inc. Homeowner accepts full responsibility for new contractors work to include, finishing of windows, sliding door, and siding. No work by new contractors or homeowner is to be completed under Verner Finishes permit. Homeowner gives complete release to Verner Finishes Inc. for accepting the reduced final payment. r . �- Norma • etl Y• 1 • Homeowner Jl�. Date_ lly erner Finishes, . - nFractor I,�,a.QYLu',. ^:ifw`fs+n:• , nod 4r e VAI N ' e� y f n ",. krT k 11'}l. fir; A] .i3 +�f �e�.. �� ,�1' ?`''L C' s � '�'r. `� f�'��W� �''+s�iJ �. is .`6 r��;R•'�� Ae? ,�, �i L ^ � r� � °'�, T � •a�' �a � ,.m 't �w+A� �-. �t1 a s\3t+1'L�!r Y �� i� r r -.er; vi k R s ^ >e tK•.� p yid fit .i�n` - 'n '�i i5 )�,�" C . ++ q. -i.� ', ',e.. �Y, i e�• l '. � � i •G �r-�i� s�y ^Lr's'' i � �v 4 � '.. � � .5..�,�� g r yIIJ 419