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PRE 2010 DOCSCity of Fridley SUBJECT P IT NO. 15 31 AT THE TOP OF THE TWINS BUILDING PERMIT r CEIPT N P. L ------- COMMUNITY DEVELOPMENT DIV. r 1 PROTECTIVE INSPECTION SEC. 1 � 1 . i CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPIROVED BY 612-571-3450 910-F15 7/6/79 JOB ADDRESS 139 - 79th. Way N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13,14 4 1 Spring Brook Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE S. J. Construction 6305 East River Road N.E., Fridley 571-4560 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. CENS 5 ENGINEER MAIL ADDRESS ZIP S►EPERATE PERMITS REQUIRED FOR FOR W`HONE % 6 USE OF BUILDINGFLU ING AND SIGN& �s Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 6 DESCRIBE WORK Construct a 24' x 40' Dwelling and a 20' x 22' Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway. Provide sod in the front and side yards. Provide City with copy of verifying survey before capping. SEWER LOCATION: (Approx. 11' Deep In Street) 60.5' E. of M.H. (Inv. 851.03) WYE ELEV: 851.23 TOP OF FOOTING: 854.23 Minimum WATER LOCATION: 10' E. of Sewer Service DRIVEWAY DEPRESSION COST: 16' + 6' x $15.75 = $346.50 THE CITY OF 'F21 WYI ,nDO ., ,NOT .G R, � �efote digging call 1oc8l Wities ACCURA�1i .`CSi' ° Utlltry .t - 4116 is =fAna.:EiE1!�tt4r1�,. TELEPHONE -ELECTRIC - t;l�S tea e 'RifS 'dAT,A: IS ,R�`�O+Z/ItAt1ON PU�P4SE3 ontLY AND R SHOULD YMY THE fwoLI nom REQUIRED BY LAW ON THE ON THE Sf� WL SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. Wood Fraise OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION R-1 960 + 440 23, 704 Tota 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 $331F000 $16.50 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- $94.82 $425.Op ST TION O THE P ONCE OF CON RUCTION. PLAN CHECK FEE TOTAL FEE $24 46 $ 60.718 SI NATO E CONTRACTOR UT RI OAGENT fl I ( AT HE PROPER AL A ED IS IS YOUR PERMIT' i WSP DATE SIGNATURE OF OWNER tlF OWNER BUILDER) (DATE) 11 CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (New, Alterations, Additions, or Repairs) OWNER: aJ-s yc -rioO I kX.BUILDER: l'rc ADDRESS: Com ®'S ��s'e- `�,,ci. ADDRESS: TEL NO: VippIL02 -S 7 I- 4 S b ® . TEL NO: Construction Location STREET NO: STREET: % Q Till W LOT: 1-A 14 BLOCK: ADDITION: �j� K 106 'L -->>V1-®0 Corner Lot: Inside Lot: ?of Setback: S 5 Sideyards: p Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION 5 Front: Q Depth: Height: j Square Feet: q ® Cubic Feet: 74000 l; j- (2- Front: a Depth: Height: �� 1 Square Feet: Cubic Feet: Type of Construction: F(- ogci E Estimated Cost: To Be Completed: 19i ��3,oav Alt. A Alt. B P Proposed Driveway Width If New Opening Is Desired: 16 $ $ SEE REVERSE SIDE OF SHEET'. The undersigned her 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 applica DATE: %— 3 - % f SIGNATURE: Stipulations: P+CR.. q 4.82. S g� (4 pati. w. so 2-4.1 3w 4a g 3 x$ s r? 9 8 L4 I� aq)e(4o 16 9l.a x 1'L I I S 2b . a c'. VN coAeAwe '207C 2Z x to 44 00 cLw%,r 014.21 9.C. 2..q, L4 (o T)c 33 X, �� 1 to. Sd Sol -e— (4 loo �.So VI lig ctba )c Zj 3g = Lq 3r)kt qG 440 xg .37 3, (�g2 gd �- 4 � Q'o7.2v W, aao GERALD SWT. AVE 300 S. LOT SURVEYS COMPANY GOLDEN VALLEY, MINN. MINN. REG. NO. 4741 LAND SURVEYORS REGISTERED UNDER LAWS OF STATE OF MINNESOTA 7601 - 73rd Ave. No. 580-3093 INDUSTRIAL — JUDICIAL Minneapolis. Minnesota 55428 COMMERCIAL — TOPOGRAPHICAL CITY LOTS — PLATTING ftntrljurs tferiiftrate S.J. CONSTRUCTIVN �o c RAYMOND A. PRASCH 6917 IDAHO AVE N. BROOKLYN PARK, MINN. MINN. REG. NO. 6743 INVOICE NO. 8322 F. B. NO. 180-73 & 74 SCALE 1.- = 30' 0 — DENOTES IRON Lots 13 acid 14, Block 4, Spring Brook Park, Anoka County, Minnesota We hereby certify that this is a true and correct representation of a survey of the boundaries of the above described land and the location of all buildings and visible encroachments. if any. from or on said land. Surveyed by us this 1 % day of. May 19 79 og j r l n Signed - - LO SURVEYS COMPANY CITY OF FRIDLEY APPLICATION F04 PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: Number Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric Water Heater GAS FITTING FEES: 1st 3 fixtures Additional Fixtures Gas Range to 199,000 BTU REPAIRS $ ALTERATIONS First $100.00 each add. $100.00 or fraction NO. RATE - /07 x M x $2.00 >. m X ro x $5.00 x $10.00 x $7.00 Water of m m fa $2.00 $ ►bi c .ci A ' ate+ w w Heater -4 54 of e r. mm E YAC 4j sma al w C 0 roH0) 4 O mo r p CaU5 LO G N N - i y vi w Uo a 3 as lec Z - .1st 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer (') = New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: Number Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric Water Heater GAS FITTING FEES: 1st 3 fixtures Additional Fixtures Gas Range to 199,000 BTU REPAIRS $ ALTERATIONS First $100.00 each add. $100.00 or fraction NO. RATE - /07 x $3.00 x $2.00 x $2.00 X $5.00 x $5.00 x $10.00 x $7.00 x $5.00 x $5.00 TOTAL $ 30. o -- Job Address % �' —7 ci 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 roprosentations stated in this application are true and correct ic/ Fridley, Mn. � g 4- , 19 OWNER KIND OF BUILDING _ %> 4X- 1 �F L, USED AS > t Ikies TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO.jlp ROUGH INSP. Date Company (lam l�� �C- Ae, -e-s 6-,4` /+ %� Signed By Tel. No.y_ REINSPECTION FEE ($10.00) FINAL INSP. x $3.00 $ Date x $1.00 ' $ X $10.00 $ APPROVAL FOR PERMIT / $5.00 $ $2.00 $ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE State Surcharge $ .50 ' TOTAL FEE $ , j0 REINSPECTION FEE ($10.00) 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 66432 TELEPHONE ( 612)671.3460 August 30, 1979 S. J. Construction 6305 East River Road N.E. Fridley, MN 55432 Re: Final Inspection. at 139 - 79th Way N.E. Dear Sirs: A final inspection was made on August 29, 1979 of the above address and the following items were noted which must be completed before the structure can be finaled out; 1. Post address on structure by September 28, 1979. 2. Provide sod in the front and side yards by September 28, 1979. 3. Install joist hangers on deck joist by September 28, 1979. We will expect the above items to be completed by the scheduled date when a reinspection will be made to determine compliance. Please contact me at 571-3450 if you have any questions on these items. Sincerely, :1sa- DARREL G. CLARK Chief Building Official DGC/mh CITY OF FRIDLEY 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432 TELEPHONE ( 812)571-3450 Mr. John Doyle S. J. Cor_struction, Inc.. 6305 East River Road N.E. Fridley, MN 55432 Re: Final Inspection at 139 - 79th Way N.E. Dear Mr. Doyle: A final reinspection was. made on October 1, 1979 at the above address to note compliance with the three items outlined in our letter of August 30, 1979. Items #1 and #2 have been satisfied, however item #3, the installation of joist hangers on.the deck joist had not yet been completed - Would you please provide these joist hangers by October 15, 1979 when an additional reinspection will be made. If you have any questions on this item, please contact me at 571-3450. Sincerely, DARREL G. CLARK Chief Building Official DGC/mh F 'October 17, 1979 CITY OF FRIDL.EY 6431 UNIVERSITY AVENUE N.E.. FRIDLEY, MINNESOTA 55432 TELEPHONE ( 612)571-3450 Enclosed are copies of our letters to you dated August 30, 1979 and October 1, 1979 which -brought to your attention items that needed to be completed before the structure at the above address could be finaled. :.` A reinspection was made on October 15, 1979 and it was noted that the joist hangers for the deck joist were not installed. It was also noted that the handrail on the stairs to the basement was not installed. We will expect these items to be completed by November 1, 1979 when a reinspection will again be made. If you have any questions on these items, please contact me before the reinspection date. Sincerely, i DARREL G. CLARK Chief Building Official DGC/mh ENC: 2 J SUBJECT City of Fridley f5---9 0 6 AT THE TOP OF THE TWINS BUILDING PERMIT r ` RECEIPT NO. , _ COMMUNITY DEVELOPMENT DIV. v PROTECTIVE INSPECTION SEC. 663 r ; NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 �j 612-571-3450 910-F15 4/7/98 JOB ADDRESS 139 79 Way NE 1 LEGALLOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 13,14 4 Spring Brook Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Marsha Wyandt 139 79 Way NE 785-2409 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION O REPAIR O MOVE ❑ REMOVE X 8 DESCRIBE WORK Construct a 10' x 8' Deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. WARN M Bdore digging call tot all utility Itcationg 454.0002 REQUIRED BY LAW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING. HEATING. VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 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 @@ @ $ WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,006 .50 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF #4Y OTHER STATE OR LOCAL LAW REGULATING CON- Fir SC $.72 STRUM PERFORMANCR OF CONSTRUCTIOCN.,.� 29.25 PLAN CHECK.FEE TO AL - �x . 47 IG NATURE OF CONTRACTOR THORIZED AGENT (DATE) E PRO Y VALID E HIS IS YOU PERMIT INSp I IIATE SIGNATURE OF OWNER )IF OWNER BUILDER) IDATEIDG J NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 6 a6 BUILDING PERMIT APPLICATION (9 ConstructionAddress: I +� CO- T i p p s Legal Description: Owner Name & Address:t Q Tel. # 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 IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length / D Width Hgt/Ground la Sq. Ft. LD Vf�7 OTHER: /'7, G0 Construction Type: A Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft Ft x $ = $ DATE: K — 7 — 9 5' APPLICANT: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control $ • �� $ $ • 7� Park Fee $ Sewer Main Charge $ TOTAL STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side Tel. # .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 [ ] $ y7 '�_ " GERALD'_ TI OOAVE LOT SURVEYS COMPANY RAYMOND17IDAHO AVE NH O BRUNSWICK AVE S.- BROOKLYN PARK, MINN. MINN. EG.VALNY, MINN. LAND SURVEYORS MINN. REG. NO. 6743 MILANREG. NO. 4741 ItZQWTRRRD UNDRR LAAO Or BTATz OF UMNR00TA INVOICE NO. �$ 22 7601 - 73rd Ave. No. 560.3093 F. 8. NO. 180-73 0 & 74 Minneapolis. Minnesota 55428 " = 301 INDUSTRIAL —JUDICIAL SCALE I _ COMMERCIAL — TOPOGRAPHICAL O �p �r� ��l' fttMtP O — DENOTES IRON CITY LOTS — • PLATTING S.J. CONSTRUCTION l I L7 •�-T- (� I-�- S�'UGCO ♦ . N 1 \ 21' Ive. /S/ N in 7.9 I Lots 13 and 149 Block 4, Spring Brook Park, „i,oka County, Minnesota Revised to show foundation July 23, 19'79 We herby certify that this is a true and coned repmentation / of a auwey .of the boundaries of the above described land and As, locetioa of all ba"ags and visible encroachments, if arty. 1� ( j from or os said land. Sign Sammy ed by us 0617 dw of May Iv 79 -7 LOWSURVEYS COMPANY Design Works (R), Knox Lumber, # 220, Phone # 754-3.5.50 Mon Apr 06 20:35:12 1998 The materials in this deck will cost $1006.15 Plan ID: CQ6755 3D View fyfl, r- - �� 6vn � tt/r -fJ1f Ask For A COZ2, on Detail Sheet Before You Begin Your Project I i CITY OF FRIDLEY INSPECTION DIV. Effective On May 10, 1999 6431 University Ave NE Fridley, MN 55432 VDA)C) APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 572-3604 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Old Opening, New Fixture $ 4.00 nal Shower .� �.�•.-.TStones . .Gas Wash : ... . Floor rain �;�..`�:..:>_:> Auto. �� ���r. Washer Gas Rana I'� `•''"'�=����>v Water Heater $ 7.00 ..:.Uri lec E Basement $ 7.00 Water Heater - Gas** �_ $10.00 Gas Range** $10.00 Gas Dryer** $10.00 Back Flow Preventer Required ( )Yes () No Type Floor 1 I F oor 2 Floor loo 3 Floor 4 M - Kim Elm PLUMBING FIXTURE RATES: NO. RATE New Fixtures e $ 7.00 Old Opening, New Fixture $ 4.00 Beer Dispenser $ 5.00 Blow Off Basin $ 7.00 Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Water Heater -Electric $ 7.00 Water Heater - Gas** �_ $10.00 Gas Range** $10.00 Gas Dryer** $10.00 Back Flow Preventer Required ( )Yes () No Type $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE TOTAL JOB ADDRESS_ S (JWIU>�� �jG4tJ The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. WYANDT, MARSHA 139 79TH WAY NORTHEAST FRIDLEY, MN 55432 Owner_ (763) 785-2409 e'/S , -a v Building Used As Estimated Cost 40r��M PERMIT NO. (� PLUMBING COMPANY LJ© Ke)L-O [ )�M/31M a SIGNED BY TEL N0. P B27-11033 WU Approved By Rough -In Date Final Dat $ .50 uunuIua rcr no w►w n1 InMouv±u±AC% nL'surr Ed% d -^O% nn" $ 20.60 **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES. CIIYOF FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN 55432 - (763) 571-3450 - FAX (763) 571-1287 February 11, 2002 Marsha Wyandt 139 79" Way NE Fridley, MN 55432 Re: Final Inspection at 139 79`h Way NE Contractor: Norblom Plumbing Dear Ms. Wyandt: A plumbing permit was issued on September 20, 2000, to install a water heater at your address. According to Section 4715.2800 of the State Plumbing Code, a final inspection shall be conducted on the plumbing authorized by this permit. As of this date, no inspection has been called for. The permit fee that was paid covers the inspections 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 permit 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�FFR DLEY INSPECTION 6431 University Ave NE Fridley, MN 55432 (763) 572.3604 RATE SCHEDULE DIViSION Effective On January 1, 2002 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOBADDRESS-1-3q -W1' Wau OWNER__ IlLY�Sh0_ 1A), in nrL-L 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% 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. TOTAL J BUILDING USED AS_ t ESTIMATED COST � � c1 �5, �� PERMIT N0. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $ Trade Name Size No. BTU HP EDR $ �L Fuel Total Connected Load Burner Trade Name Size No. $ BTU HP EDR A L� )4b�314 �ctnHyn1 a+C�n $ 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 A6 5-0 representations stated in this application are true and correct. DATE-/,/� 2/6 2 HEATING Sig TEL # _7.3.757 3DVL FAX # (05 --757 — 575 Approved By Rough -In Date Final Da THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED r-nMM(]N VFNT, VFNT CQNNFCTOR AND CnMR1 IRTIQN AIR V RIFT CATION When rp In acing 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 comb is inn air is sized and installed to meet the current codes and manufacturer's specifications. ' Yes () No ( ) When required to install a naw rnmhimtoon air, it will be sized and installed to meet the current codes and manufacturers specifications. Yes () No ( ) When ins ailing a new v _n ing systam, 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 #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 HEATING CO: igned By: Date : Building Inspections 763-572-3-604 DATE Z / SITE ADDRESS .� THIS APPLICANT IS: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR E-MAIL ADDRESS ,LOWNER ❑CONTRACTOR Permit No.: Received By: I' ® Date Rec'd: 7/ UL PROPERTY OWNER/ NAME: Mar5hct 1W aAc(� See Back Page for Fee Schedule 3 5 1v �i� CITY i STATEA*P TENANTADDRESS: Fire Surcharge PHONE %63 7��'Z ydg .001 times the total job valuation CONTRACTOR NAME: .0005 x Permit Valuation Minimum $.50 STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE ZIP WITH APPLICATION PHONE FAX $ PROPERTY TYPE ASINGLE FAMILY/NEW CONSTRUCTION SIZE $450 Conservation Plan Review ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS Agreement necessary ( ) Non Necessary ( ) ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE Make checks payable to: City of Fridley Attach Stipulations ❑ DECK ❑ SIDING 4 OTHER ❑ SWIMMING POOL TYPE OF WORK: XrNEW ❑ ADDITION ❑ MAINTENANCEIREPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: �ie G� v� ��� n�✓� �r���x. r S �� Y1 �� HEIGHT Sq. Ft. SIZE OF IMPROVEMENTS LENGTH WIDTH ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2• 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 ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes []No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS AT T VVRc AT?V RAQV,n n1V VAT.TTDTTf1N_ INC TJTDTNti THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ -000 - 0-0 OCCUPANCY TYPE Permit Fee $,� �b See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ 100 .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge $ $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 $20 = $ 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 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 .8y_+�which requires /review and approval of plans. SIGNATURE OFAPPLICANTy PRINTNAML %��AT DATE q-27-06