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PRE 2010 PERMITSApplication for Power Plants and Heating, Cooling, Ventilation, Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE 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 TOTAL $ $ 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 $ S GAS PIPING (Up to 3 Fixtures) $ ................ 1.50 J. (Add 50c each over 3) AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS REMARKS: $ See Fee Schedule $ TOTAL FEE $ Dept. of Bldgs. Phone SU 4-7470 r Location ,� �� ✓f - '-`'nom ' C11,` 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. Owner '7 -�- Kind of Building Used as ri To be completed about 195-22 195- 195— Estimated Cost, $ jOldrNew. Building Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS Steam,; Hot Water, Warm Air—No.— Trade Name Size No. Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Loa Kind of Fuel BURNER — Trade NameSize No. Capacity Sq. Ft. E.D.R. BTU %Z-, H.P. Sign g�, .,:, ECTION HEATING COMPANY, INC. 2936 FOURTH AVL SO. + TA. 3-5287 OEED-11 POST 1M-8-58 Busing;Rhos do $ MINNESOTA • 10 city ofFridley, Minn. BUILDING PERMIT N? 6708 Date: _'___V_ __ _.__......._......._... .._ r Owner:4�:...... J Builder _. L. .. .. ....... .... ....._. Address . ............ ....... ............ ..... _.............. _ Address _..__....._..._.__....._........ .... ......................................... _...._.__......_..__....._. � L ON OF UILDING No... ----........._..._::....%Street .... t. -- -- ! ............. --........... Part of Lott.....---�./......._.51.......... -................. - ._ .........!21. Lot..... . ............. _............. _ Block .......................... _............. ............ _. Addition or Sub -Division ............... Corner Lot ...... ...................... Inside Lot .....- ............. Setback ..... ........ _.......................... Sideyard ...... :...___.% `�'`'�- ._ Sewer Elevation....._......._...._............._........_..._......._...._......._...._............._......_ Foundation Elevation DESCRIPTION OF BUILDING To be Used ast //�� __ / '14411 .... __� iont ,[._.. Depth ...1 _ _ Height Sq. Ft. Cu. Ft. Wof Front _J__..._ _.. e th .... _. Height ....,�L.r._ Sq. Ft.� Cu. Ft.�.... Construction ;{ Est. t�....s�.._.:'�..............`.... o be Complete d....._..._.._-----•---._.._.__..... In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all revisions of ordinances of the city of Fridley. _ I In consideration of the payment of a fee of $.....1.. ................ 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 owithin the rdinances. city limits and this permit may be revoked at any time upon vioon of any of the provisions of said d. Building Inspector NOTICE: This permit does not eovor the construction, installation for v 60esi, plumbing, gas hosting, swrer or water. Bo sure to "a the Building Inspector for separate permits for thea items. �e / APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNEER ° S NAME I- {0 W006 MAOM BUILDER L -Y IJ w9afl Md NO2 i IJG ADDRESS 57W 974sT P -j DCA b, ADDRESS %O AgZHITec,i W, i3: Y-6jjUA)t5T4 DIOL MI OUL-T07'q LOCATION OF BUILDING No. 570(9 Street GZs-r RIJtV2 p.94p Part of Lot Lot Block Addition or Subdivision Corner Lot Inside Lot Setback SEWER ELEVATION Side -Yard (p 1 W O , FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed build- ing location drawn on these Certificates. PAfZT OF 1,0T i T Qv1)i-r0& S SSB-Dlv(SIQi(1 '%i� DESCRIPTION OF BUILDING To be used as: j 0 P!,S 1()& R()ME "K1 r w iw Lr Front Depth t-,, Height 10 PEA2 Wi)v(r Sq. Ft. bdMA $ ZSG Cu. Ft. FrontI - g Depth ¢(o Height JC) TOM L Gveac 17v,000 �, d3� Cu. Ft. 7O38U Type of Construction L04D —� yp 09ZP1 )b RLOGG-aV4. iADF Estimated Cost 0270,000 To be Completed JOyu , (q¢ 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 truo, and correc ��, DATE RTrNATTTRE 21 (Schedule. of Fee Costs can be found on the Reverse Side). Application for Power Plants and Heating. Cooling, Ventilation, Refrigeration and Air Conditioning Systems 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 r Furnace Shell & Lines—to 400 sq. ft. EDR Steam ... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water .. 8.00 $ 2• Each add. 200 sq. ft. EDR Steam . . .................. 2.50 $ `r Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $_�S_ i 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: NO RATE TOTAL 1st 3 Fixtures x $1.50 $ Additional Fixtures ................ x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS See Fee Schedule $ TOTAL FEE 'S 3. -,22- Dept. of Bldgs. Phone SU 4-7470 Location C" ? 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. r -2 / eZ, 19 Owner Kind of Building Used as 4F . To be completed about o c� Estimated Cost, $ Old—New. Building Permit No. 6' _7a Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, EWateDwarrn Air—No. Trade Name_�F� E'eae_- Size No. 6067 3 Capacity Sq. Ft. E.D.R. BTU o H.P. Total Connected Load 3 6 � *3 4 f T4 _ Kind of Fe 1---Eif BURNER— Trade NamSize NoZ yyn Capacity `,C Sq. Ft. E.D.R. C _ BTU .2G v H.P. ROUGH . k1r a z 2M FINAL.��--- (REMARKS—OVER) Signed 1"�b` By L Business Phone No. 2 7 5_ 3� 'D O 1=B=R CALCULATION SHEET 1502 Copyright 1960 by the Institute of Boiler and Radiator Manufacturers, 608 Fifth Ave., New York 20, Y• OWNERLG G, / ADDRESS ��//I% I%2 TYPE OF BUILDING _,A1U,CSlA.)!5 CONSTRUCTION DATE — _ DESIGN TEMPERATURE DIFFERENCE F. 111 11 UA <O COL. A COL. B 2-' COL. C COL. D / COL. E 7� COL. F I I Roots ,9,-/)le"-."/J.:fD QQ a---+%LCD•ss-a Q v �do n 134r."I H L H L W H L W H L W H L W H L I W /� 2 ROOM DIMENSIONS. FT. 3 V �u BTU/HR REQUIRED BTU/HR REQUIRED JJ �J BTU/HR REQUIRED J J J '/� 5 I GLASS AREA. SQ. FT. I /G-�6 3 LENGTH EXPOSED WALLS. FT. BTU/HR REQUIREDjaREQUIRED BTU/HR / / REQUIRED BTU/HR REQUIREDFROM ROOM TOTALS LINE S1 4I GROSS WALL AREA. SQ. FT. - 5I GLASS AREA. Sq. FT..30 NET WALL AREA. Sq. FT.Zg �0 Q(J✓y IBTU/HR Q0-0 `Q % LTtI6 •� B 7CEILING AREA. SQ. FT. Q 6CJ 28 I/'y Z 8 I FLOOR AREA. SQ. FT. } - .( X Y _1 �__ fTV T .l _�_9 _Q7A_ _____ TOTAL BTU/}IINFILTRATION OF BUILDING ,yT DESIGN TENp. DIFFERENT 9 ROOM VOLUME FOR INFILTRATION CU. FT. IFI -------------- -------------- �Z Q E F 10 TOTAL BTU/HR AT 70F TEMP. DIFFERENCE' 1 1 TOTAL BTU/HR AT DESIGN TEMP. DIFFERENCEZ. 12 HEAT DISTRIBUTING UNITS Q _ X/ COL. A L. G ?-' COL. H COL. 1 4 COL. J / COL. K 1 Roots ,{3i1rH _ � �'azh ,c�� �✓i %ol �ileL ?? 1-3zo H H L I W H L W H L W H L W H L W 2 ROOM DIMENSIONS, FT. /v �� I ��/ v f. / ) 4: /� `O 3 3 LENGTH EXPOSED WALLS, FT. C BTU/HR ! �QF�QU BTU/HR REQUIRED BTU/HR REQUIRED BTU/HR REQUIRED �J BTU/HR REQUIRED J 4 GROSS WALL AREA, SQ. FT. J '/� 5 I GLASS AREA. SQ. FT. I /G-�6 NET WALL AREA, SQ. FT.d7I CEILING AREA, SQ. FT. FLOOR AREA, SQ. FT, t �a �� �Z�"V 28 2v &tj 69 ROOM VOLUME FOR CU. FT. - - .( X Y _1 �__ y� __ �"Y___ / 3 Q I_____17� __ _ ✓�a____ -___ % ]/� / • ..... ___ J_ _ ___ _�_9 _Q7A_ _____ TOTAL BTU/}IINFILTRATION OF BUILDING ,yT DESIGN TENp. DIFFERENT 10 TOTAL BTU/HR AT 70F TEMP. DIFFERENCE* 1 1 TOTAL BTU/HR AT DESIGN TEMP. DIFFERENCE �Z Q �(� Z 12 HEAT DISTRIBUTING UNITS -INCREASE t3ATHROOM TOTAL 20% X�orl VA; �O WOR CONCRETE FLOOR ON GROUND OR FILL AT GRADE LEVEL, USE LINEAR FEET OF EXPOSED EDGE FORM 1�.oz on' _.-. _ ,._ .. .... , TA =B=R CALCULATION SHEET 1502 Copyright 1960 by the Institute of Boiler and Radiator Manufacturers 608 Fifth Ave. New York 20 0 COL.—B ?� HH L W 17 L BTU/HR 2.)f a I REQUIRED DDRESS ���r% %�Lu'� DATE ONSTRUCTION COL. C / COL. D COL. E / COL. F / Ae4 TYPE OF BUILDING Uiesloi< J% 41 -.All 1510 ro1;11 DESIGN TEMPERATURE DIFFERENCE L W H COL. A I W HH L 11 Room H L W I d BTU/HR REQUIRED BTU/HR L/ REQUIRED lb O 21 ROOM DIMENSIONS, FT. r"-- ox!` BTU/HR REQUIRED 3 LENGTH EXPOSED WALLS, FT. !OM 4I I GROSS WALL AREA. SQ. FT, _ "..{,a>I _111 5I GLASS AREA, SQ. FT. qA a� 6I NET WALL AREA, SQ. FT, N (co 7I CEILING AREA, SQ. FT. /60 8I FLOOR AREA, SQ. FT. t 9 ROOM VOLUME FOR INFILTRATION CU. FT. YCf 10 TOTAL BTU/HR AT 70F TEMP. DIFFERENCE' - 1 1 I TOTAL BTU/HR AT DESIGN TEMP. DIFFERENCE 12 HEAT DISTRIBUTING UNITS 0 COL.—B ?� HH L W 17 L BTU/HR 2.)f a I REQUIRED DDRESS ���r% %�Lu'� DATE ONSTRUCTION COL. C / COL. D COL. E / COL. F / Ae4 54r�-f 41 -.All 1510 ro1;11 H L W H L I W HH L W H L W I d BTU/HR REQUIRED BTU/HR L/ REQUIRED lb O BTU/HR REQUIRED 7-9 BTU/HR REQUIRED 9 51 GLASS AREA, SQ, FT. I / �/ _ "..{,a>I / Q — 5'a qA a� 2.6 Z__ Cy¢3 (co /60 . ev YCf 6 NET WALL AREA, SQ. FT. 7I CEILING AREA, SQ. FT. I 4 8I FLOOR AREA. SQ. FT, t 9 ROOM VOLUME FOR U INFILTRATION ------ ------- – --- -[,J i4� CU. FT. ff YY 10 TOTAL BTU/HR AT 70F TEMP. DIFFERENCE I 1 TOTAL BTU/HR AT DESIGN TEMP. DIFFERENCE x/ 'INCREASE BATHROOM TOTAL 20% ox` On 1 �ti .of COL. 1 #00 c=oL• A COL. G / COL. H / f ivA7-4 1 ROOM 9 A 1510 I L W H I L W H L 1 W ox 1 <O� 2 ROOM DIMENSIONS, FT. D S BTU/HR REQUIRED BTU/HR BTU/HR 96 REQUIRED t v / 3 LENGTH EXPOSED WALLS, FT. O BTU/HR REQUIREC 4 I GROSS WALL AREA, SQ. FT. 51 GLASS AREA, SQ, FT. I / �/ _ "..{,a>I / Q — 6 NET WALL AREA, SQ. FT. 7I CEILING AREA, SQ. FT. I 4 8I FLOOR AREA. SQ. FT, t 9 ROOM VOLUME FOR U INFILTRATION ------ ------- – --- -[,J i4� CU. FT. ff YY 10 TOTAL BTU/HR AT 70F TEMP. DIFFERENCE I 1 TOTAL BTU/HR AT DESIGN TEMP. DIFFERENCE x/ 'INCREASE BATHROOM TOTAL 20% ox` On 1 �ti .of COL. 1 #00 COL. J O COL, K 161--60 4&0-1 f ivA7-4 0 FFi e /z, H L W H I L W H I L W $ /!o Z, d Y 1:2 f 2- BTU/HR BTU/HR 96 REQUIRED BTU/HR 6— REQUIRED BTU/HR REQUIRED Ch " Z b qA a� 3 WOR CONCRETE FLOOR ON GROUND OR FILL AT GRADE LEVEL, USE LINEAR FEET OF EXPOSED EDGE B=R CALCULATION SHEET 1502 OWNER �/% GL<<%Cl� A725,LJR1 !-{ A, TYPE OF BUILDINGA4/C 16J! b' +r L. C DESIGN TEMPERATURE DIFFERENCE _F. DRESS_ NSTRUCT �xc i Copyright 1460 by the Institute of Boiler and Radiator Manufacturers, 608 Fifth Ave.. New York 20. N. Y. DATE 1 r" 1 COL. A COL. B / COL. C / COL. D / COL. E 2 COL. F Y 1 Room e3 r - M c/ AJ L, 1- t /n if �/ S e, A:L y%S E/y/f111% 2 ROOM DIMENSIONS, FT.�yl rl I L W H L , y�b W H L W 2'��,f H �. L f ! W I �� H �[6 I L W 3 LENGTH EXPOSED WALLS, FT. BTU/HR Q REQUIRED BTU/HR -Z REQUIRED D BTU/HR �� REQUIRED BTU/HR 1 REQUIRED BTU/HR REQUIRED 41 GROSS WALL AREA, SQ. FT. I_ 5 I GLASS AREA. SQ. FT. rL t? as J s K 3 LENGTH EXPOSED WALLS, FT. 6 I NET WALL AREA, SQ. FT. N bL ,,© Z 2 2.Y 6 `� 'L : - e-0 I Z Z _ e -o D 61: '� 8 e-0 71 CEILING AREA, SQ. FT. E31 FLOOR AREA, SQ. FT. } G'}.v .'L l '�C �},.0 5 I GLASS AREA, SQ. FT. I 9 ROOM VOLUME FOR INFILTRATION CU. FT. V _____________________ _ ____--------------- ����rr iii'��__. !' / Seo j ///' 6 NET WALL AREA, SQ. FT. ---------------- 10 TOTAL BTU/HR AT 70F TEMP. DIFFERENCE* S 0 .I AEy 1 1 I TOTAL BTU/HR AT DESIGN TEMP. DIFFERENCE 7 I CEILING AREA. SQ. FT. 8I FLOOR AREA, SQ. FT. } }( (S 2— A Q x/ -i 12 HEAT DISTRIBUTING UNITS 9 COL, A COL. G COL. H COL. 1 < COL. J COL. K 1 ROOM PIAJI h� S /�n ,r �O�' • 1 /�!%r2 y%S E/y/f111% H I L I W C L W H W H W H L W 2 ROOM DIMENSIONS, FT. G �+ /3 (i S (a S I_ /L Go rL t? as J s K 3 LENGTH EXPOSED WALLS, FT. BTU/HR 3693 C, BTU/HR REQUIRED BTU/HR REQUIRED BTU/HR REQUIRED O BTU/HR REQUIRED 41 GROSS WALL AREA, SQ. FT. o f/—REQUIRED /' V /' Q 5 I GLASS AREA, SQ. FT. I Y� 6 NET WALL AREA, SQ. FT. 1 Z �.S'6fi S 7 I CEILING AREA. SQ. FT. 8I FLOOR AREA, SQ. FT. } IIO A Q 3 c -z) O 9 ROOM VOLUME FOR INFILTRATION CU.FT. U __iICyC__--- 1Y__.1�.[___ �_I__'�-4�___ ..1!_f!_SJ_____ J__IGt_YC __ __Y� ___ _____________ -------------------------------- ________________CU. 10 TOTAL BTU/HR AT 70F TEMP. DIFFERENCE* 11 TOTAL BTU/HR AT DESIGN TEMP. DIFFERENCE V 1^ / !{ — �. 12 HEAT DISTRIBUTING UNITS *INCREASE BATHROOM TOTAL 20% Room I TOTALS FROM LINE 1 I ¢a %r wo ,XU B C D E F G H I_ as J (wo xu' K i~ 3693 C, TOTAL BTU/HR OF BUILDING AT DESIGN TEMP. DIFFERENCE }FOR CONCRETE FLOOR ON GROUND OR FILL AT GRADE LEVEL, USE LINEAR FEET OF EXPOSED EDGE - - FORM 1502 mIL o Application for Power Plants and Heating, Cooling, Ventilation, Refrigeration and Air Conditioning Systems 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.b0 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 $ / Q O' OIL BURNER—to 3 gal. per hour 5.00 $_S2! over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5:00 $ GAS FITTING FEES: NO TRATE TOTAL 1st 3 Fixtures x $1.50 $ — Additional Fixtures . ............... x .5.0 $ Gas Range to 200,000 BTU ........... x 2.00 $� - AIR CONDITIONING �� _ 60 FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS ROUGH FINAL TOTAL FEE $ 0/ 40 , Dept. of Bldgs. Phone SU 4-7470 U" Location �~ %d /> G Q'.o� �v Gt►--,e 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. ZAZI ;7— 196 Owner Kind of Building Used as e To be completed about O Estimated Cost, $ �o� 0 Old ew. Building Permit No. Permit No. c.;;)Z ll DESCRIPTION OF WORK HEATING or POWER PLANTS—,.Steam, of ate Warm Air—No. Trade Name 12 �zCz Size No. C U G 3 Capacity 2 P 4'O Sq. Ft. E.D.R. ��� �— BTU_____ -!;?_ O H.P. Total Connected Load t3 a 21, -316' �2 & Kind of Fue1�l�'� BURNER — Trade Name E%y Size No. C d Capacity q !i Sq. Ft. E.D.R. BTU H.P. (REMARKS—OVER) Sig C,, CE4 11c__ By - <= 2M Business Phone No- City of Fridley Application for Plumbing and Gas ming Permit Dept. of Bldgs. Phone 580-3450 DESCRIPTION OF WORK Number, Kind and Location of Fixtures Location /21 v Q Z Future Connection Openings I wnsa.as.a ` iza * New Fixture, Old Openings Sewer F1 Cesspool j -j PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures Future Fixture Opening New Fixture Old Opening Catch Basin Water Heater (Up to 99,000 BTU) .. . New Ground Run Old Bldg. Electric Water Heater GAS FITTING FEES: NO. lot 3 Fixtures ...... .................. Additional Fixtures . . . ......,....... Gas Range to 199,000 BTU . .......... . x $2.00 z $__ x $1.50 $_ x $1.50 $ x $3.25 $ x $3.00 $ x $3.25 $ $2.00 $ RATE TOTAL x $2.00 ; x$.75 $ i ±F $ Z Z �j, Z Z O W e WATER HTR. < •� y w < 3� o� K �0 y 5 Z 7 t t f N GAS ELEC. e3 <3 U 0K C70 Base — — --- — lst — --- 2nd -- 31 d - -- 4th Future Connection Openings I wnsa.as.a ` iza * New Fixture, Old Openings Sewer F1 Cesspool j -j PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures Future Fixture Opening New Fixture Old Opening Catch Basin Water Heater (Up to 99,000 BTU) .. . New Ground Run Old Bldg. Electric Water Heater GAS FITTING FEES: NO. lot 3 Fixtures ...... .................. Additional Fixtures . . . ......,....... Gas Range to 199,000 BTU . .......... . x $2.00 z $__ x $1.50 $_ x $1.50 $ x $3.25 $ x $3.00 $ x $3.25 $ $2.00 $ RATE TOTAL x $2.00 ; x$.75 $ x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code , Description ........... TOTAL FEE ; 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 fact and representations stated in this application are true and correct 3- Fridley, Minn' Owner 'Z C c% v Kind of Building b�•2s�_ Ir �r Used as To be completed about — r- n Estimated Cost, $�� Old—New. Building Permit No. Permit ?sem.-------.= Signe 7� Bye Business Phone :3 Y� ROUGH FINAL No Original Permit for PLUMBING AND GAS FITTING N.B. When work covered by this permit is ready, the Plumbing Ordinance requires that request for Permit inspection shall be honed in to the plumbing Inspector, 560-3450 vin number of this I Fee � Zf 0° 1 P P g P giving Permit., DESCRIPTION OF WORK Number, Kind and Location of Fixtures City of Fridley Ul N N � W Q N Y ~ W I to Stories F Z Y Ul Z U O Z = Z 3 Z U J W WATER HTR. GAS ELEC. O Q J 3 U K ❑ F- M Q 7 m F- U) Q M 2 U1 Q Q 0:D: 3 F O ❑ LL 2 N O Q F- M J M ¢ Q LL ❑ U m X Q❑ D: J N x LL 0 ¢ h l7 Q N 2 Q < U D: Basement 1st I 2nd 3rd 4th I l Connected with Sewer -Cesspool Gas Piping for Openings Permission is hereby granted to do the plumbing and gas fitting in the building described in the statem44t hereto attached, upon the express condition that the person to whom this permit is granted, and his agents, employees and workmen, in the plumbing or gas fitting of said building shall conform in all respects to ordinances of the City of Fridley, and this permit may be revoked at any time upon the violation of any of the provisions of said ordinances. By Order Of The Inspector Of Buildings Roughing in Inspection Inspector. Final Inspection Date nspector. 4 29 M -6 -6S -V Ownercz Location Kind of Building Used as c To be Completed_ ???, 19 Estimated Cost $ i�5-0 .6--,, Old -New. Building Permit N Inspector of Buildings. -° City of Fridley, Minn. 1 1 2 3 8 6431 University Ave. N. E., Minneapolis, Minn. 55432 BUILDING PERMIT Date: Nov amh ar Owner: Lynwood Manor Nursi�ngHome Builder __Same Address _ 5700a.&L_Bauer_.RQ_as1...N—F------------...._.._. Address _..S.amle. LOCATION OF BUILDING Na - 5700 Street __ __R],.Y. x os d---------•----......_-----.---.....--.-.........._... Part of Lot Lot Block ___.__..___. _—._.._.....__.-._ Addition or Sub -Division ._..7 $�_.__._....._...._....__....__ �_.._.._. _. r_ Corner Lot __..._ Inside Lot ._ _......-•-•--•--__....___ Setback ..... ........................ _......... Sideyard ............... ._--._..._ _ __......_.._... __.. _ _. Sewer Elevation ..._........... _..._.._____..____.____.__....._ Foundation Elevation .---.__....._ ............................._ DESCRIPTION OF BUILDING To be Used as: Repair and recover roof _._ Front ti__ Depth ___ Height ............_..._.. Sq. Ft . ..................... Cu. Ft. Front Depth _ __ _ Height ....._............... Sq. Ft. •-----........... -_ Cu. Ft. ._.-•--••-.-. _ Type of Construction .._ ................_....__..__.__.____....__ Est. Cost __.$3,20.0....00. ... ............ To be Completed------2---month .__._ In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above forth and in c liance with all provisions of ordinances of the city of Fridley. Z z� el 1.60 State Surcharge In consideration of the payment of a fee of $__2_1_&0____, permit is hereby granted to._LynW.Q.Qd_lanor Home _.._...�_.......... .... _.......... __ 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 }yithin the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. ,r G � _ _ g Inspector CLARENCE BELISLE 1 NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. a APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY_,,, MINNESOTA OWNER'S 14WE; BUILD ADDRESS • G5 / ADDRESS ' .!6^G .✓ ,�f �� . N0:..3"%D STREET.�iL�-emsI— ' LOT: L BLOCK: ADDITION: 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: Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: Estimated Cost: To Be Completed; The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in sttict 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:`% / T�� (See Reverse Side For Additional Information.) City of Fridley, Minn. -11552 6431 University Ave. N.E., Minneapolis, Minn. 55432 WRECKING PERMIT ate: _ July 20, 1972 Wrecker Owners _ Lynwood Manor Inc. ��r/ Same-. Address _ �Z Q2E3�12 .LY._o;.�`I �E .._ Address _.._ _. _ _.._.__.._._.._._.................... _................. LOCATION OF BUILDING Na 5700 Street __East River Road.N_E._..... _............................. Part of Lot Lot Pr - 1,8. Block Addition or Sub -Division .._._....AuLLtt ....... Corner Lot Inside Lot _._____.----•--_....-__-. Setback ............................ Sideyard .............. _._.___ Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Wreck older structure at this address Front _ 36 _. Depth 45 Height -_3 __S t or i §Q. Ft. .................. _. Cu. Ft. ..._._ Front ____ Depth Height ....._.............. Sq. Ft. ___ Cu. Ft. Type of Construction Est. Cost _ _$3OQ.._QQ....._.__.._.... To be Completed -.--_6.....M n-tha__._..___ In consideration of the issuance to me of a permit tocon?5wct the building desc ' ed above, I agree to do the proposed work in accordance with the description abov forth and in comp ' ce rovisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ 34.00__-__ permit is hereby granted to._ Mr_. -__.Russell Olson _ __..._..._........._. _ to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects -to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings Within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. l!�-B S or CLARENCE BELISLE NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to sw the Building Inspector for separate permits for these items. . 4 APPLICATION FOR WRECKING PERMIT No. Fridley, Minn., �•-19L� Inspector of Buildings, 6431 Univ. Ave. N.E. The undersigned hereby makes application for permit to wreck the building as herein specified, agreeing to do all work in strict accordance with the City 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. LOCATION OF BUILDING No. Street Part of Lot Lot Block Town. Addition or Sub-divi_ion Taxes Paid To be Completed C DESCRIPTION OF BUILDING Front Depth Height Stories Type of Building and Construction No. of Dwlg. Units Taxes Paid To be Completed C /J Apprpved by: L�er &Sewer Department Utilities Notified: Minneapolis Gas Co. (date (Title) Northern States Power Co. (date) (Title) Northwestern Bell Telephone Co. (date (Title) ` Wrecker GENERAL INSTRUCTIONS I (See Copy on Other Side) GENERAL INSTRUCTIONS The following must be secured before wrecking permit will he issued: 1. Tax receipt showing that all real estate taxes due have been paid. Dup- licate receipts may be obtained at Anoka County Audtor. 2. Approval from the Fridley Water and Sewer Department showing that bills chargeable against the property to be moved have been paid and water connections have been discontinued at the curb line or at the main. (See reverse side of form.) 3. Notification to, and signature of utility companies: (See reverse side of form.) (a) Minneapolis Gas Co., 739 Marquette Ave., Engineering Department, Fourth floor. (b) Northern States Power Co., 15 South 5th Street, Application and Extension Department. (c) Northwestern Bell Telephone Co., 224 South 5th Street, Business Office, First Floor. 11 ::� 250-8-58 •rt r� w U N y at G s+ f+ 41 � u .0 m m u� b '47 44 W as "e+ to 41 r•1 O 4 3; 43 O 4110 %04 G -v4GO TJ 41 41. 441 G •' I 0 41 0 0. O 03 tJ •? 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JJ a�6 O +1 G m 4J 4) 41 O w 41 43 41 V 4J ,r3 co w 4J 41 41 41 m cc rG >, d W H '' G w O • 41 .-4 N M �7 4 Q, 44 H .-dt cd - �aw �0 ' Ort V gZi Qf C-5) ccf7-� •rt r� - .. •'��t-•--sem--- � _ .(J'?.�?� '��' �% , � �-=c -•_ ,_ --J" l'1 A , M, s lara P.�if,-�a.;�^:'.^u ,I� �qi re.;.. 4 [�/ %�.«. as f • AI�°.Ca�ar�39r �.���'5ay andd.y:um��.� CWvv{+.u.�9 �rErmd�L'.i �;+��o ��'�rr� �v)�"�r 96i and Air Cana f Eoadng Sys: ea-ras cad Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone 560-3450 GRAVITY WARa'A AIR: RATE TOTAL Location -f) ' C L" �. F " f ez- FurnaceShell & Duct Work .......................... �:a $ $10.00 Replacement of Furnace ............................. ti k $ 6000 Repairs & Alterations—up to $500.00 ................ * $ — 6o00 Repairs & Alterations each add. $500.00 ............... $ 3.00 MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ..:......... ( $ $10.00 each add. 60,000 BTU ....................... ? 3 3.00 Replacement of Furnace ........................... $ 6.00 Repairs & Alterations—up to $500.00 ......... ....... � l2 $ 6.00 Repairs & Alterations each add. $500.00 $ 3.00 STEAM or FOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam .... k�`.k $ $10.00 Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... Wig$ 10.00 Each add. 200 sq. ft. EDR Steam . " a 3,00 Each add. 320 sq. ft. EDR Hot Water ... .............. 'jbc $— 3.00 OIL BURNER—to 3 gal. per hour ... ... .... ' _'Z : $-- 600 • over 3 gal. per hour-15ee Fee Schedule 199 000 , r GAS BURNER (up to T :BTU) ! . "' .. l �' / 4 C) 5.00 $ ry ; 199,000 BTU, .... GAS FITTING g5: NO RATE TOTAL 1st 3 Fixtures x $� $ Additional FixtUres, ... , . .. x Mt7. $ Gas Range to 7 $ x 2.00 AIR CONDITIONING FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS 'TOTAL FEE $ ROUGH_- FINAL - 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- ,1 Owner Kind of Building, Z0/L/' Used as To be completed about d <, Estimated Cost, $__ -1 �' n OldZN ew. Building Permit No. Permit No.— ,�_7 DZSCFIPTION OF WORD HEATING or POWER PLANTS—Stearn, Hot Water, Warm Air—No._ __ Trade Name_��1� L Size No. Capacity Sq. Ft. E.D BTU__ H.P. $2.00 Total Connected Load_— Kind of Fuele' •75 BURNER — Trade Nam Size NoI ZA3 • G c; ���} �{y5o00 /.0 4E i _ q. Fti . BTU Capacity Signe \/d2 1&���������t� r •2 Business Phone No- (REMARKS—OVER) App2ica" Igor Power Maefs sed H49thM COOling. VOMIO N. R,8111WOW W mid Air COndhioning Sptem and Devices PARTIAL RATE SCHEDULE Dept. of Bldoa. Phone SW -UW GRAVY -TY WARM AIR: RATE TOTAL Furnace Shell & Duct Work $10.00 $ Replacement of Furnace 6.00 $ Repairs & Alterations -up to =500.00 6 00 Repairs & Alterations each add. $500.00 3 W $--- — MECIL WARM AIR Furnace Shell & Duct Worm to 120,000 BTU .$10.00 $--_ each add. 60,000 BTU 3.00 ; - Replacement of Furnace 6.00 $ Repairs & Alterations ---up to $500.00,c"=C-+ Repairs & Alterations each add. $500.00 STEAM or HOT WATER SYSTEM Furnace Shell 3c Lines -to 400 sq. ft. F.DR Steam Furnace Shel', & Line -to 640 sq. ft. EDR Hot Water 10.00 Each add. 200 sq. ft ,EDR Steam ion $ Each add. 320 sq. ft. EDR Hot Water 3.00 $-----_-_. OIL BURNER -to 3 gal. perhour 6.00 over 3 ga-1. per hour --See Fee Schedule GAS BURNER rep to 199,000 BTU) 5.00 ; over 199,000 BTU See Fee Schedule GA8 FITTING FEES NO RATE TOTAL 1st 3 Fixtures' _' -_-- _-- z$ 200 E--. - - -- _ -.-- Additional Fixtures --__-- z .75 -- Gas Range to 199,000 ;$ 5.00 $--- - - AIR CONDITIONING State Surcharge .50 FAN BEATING sT*?XM 800 F« Schedale �VENTIL_ ATIAG _STI _T136-. _ . \ / ALTERATIONS & REPAIRS TOTAL FILE ; ROUGH FINAL. % -,9,0 - % S'' 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 Ordinance; 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 -_ / /Ci�.iC?L-/rl �/y �'/� ,3✓' [ �r� 1 i i % . .c{L%.GLG Kind of Building ��%" 6,4 Used am -Ff To be completed about - _7 - l -73 Estimated rrxt, 01d -New. Bwlding Permit No. Permit No. DESCRIPTION OF WORK HEATING or POWER �PLAWIS-.,Steam, ot-Water`bVarm Air -No Trade Name��G'f/ �_ Size No Capacity- ---_---- -- _ -Sq. Ft. E.D.R BTU H.PI- Total Connected Load- -_. ____. Rind of Fuel BURNER - Trade No Size No. Capacity_ (REMARKS -OYER) --- Sq. Ft. E.D.R BTU 1r� ��R dsT S Sig �. Bye- Badness Pboot APP1icntzlan for PlumU1g c mea G z P� , a? - DESCRIPTION 0. V1012% Numbar, Iliad and LocrS;cn of Fixtures O i < The undersigned hereby makes application for a permit for the- work herei z strict acco dance with the C:t7 C r'irarce �,ztl7 Z i .� : a � � pzl�z 0� � � < � o '� < 17 u `7 < N z � � /`4, l�7 i -a o 0^ M WATER -TR. CA's ELIC. Ba`e J � d To be completed about - Es;imatrd Cost, S r- O e d c Old—New. Building Permit No. Per= it No. Signed Lil,er �u By Ist ti _, -3: 3:d i 4th • Futuro Cc=nocrcn Oponinfjs aS3ersr Mew Fixture, Old Opsaings Ccs: Pwl 0 PARTIAL RATE SCHEDULE • PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................ / x 52.00 $ '�• C( Future Fixture Opening ........... x $1.50 $--.- New Fixture Old Opening.. ....... x $1.50 $____. Catch Basin .................... x $3.25 $ Water Beater 'Up to 99,000 BTU)... • x $3.00 $ New Ground Run Old Bldg. ........ x $.3.25 $ Electric Plator Hoatar...... ........ z y2.00 $ SAS FITTING FEES: NO. RITE TOTAL Ist 3 Fixtures x 52.00 $ . Additional Fixtures x $ .75 $ Gas Range to 159.000 B i J ........... x $5.00 $ P.EPAIRS k ALTERATIONS—Aafer to Code Dept. of Bldgs. Phone SF,0-3450 I.ow--ilo a City of Fridley: The undersigned hereby makes application for a permit for the- work herei specified, a,^,reeing to do a'.1 wc-kin strict acco dance with the C:t7 C r'irarce and ruling of the Dcparinent of Bu ;dings, and hereby declares that all the fact and representations stated Ln this applica iufl are true rnd correct Fridley, b:inn ��-1,5� 2 S . - 29— / Owner �-^ / o o l�7 i -a o 0^ Kind of Building Used as J � d To be completed about - Es;imatrd Cost, S r- O e d c Old—New. Building Permit No. Per= it No. Signed Lil,er �u By o�— ROUGH .50 State Surcharge Description .........................................$ TOTAL FEES `j �Z, Business Phvne No Abe -. - / I i rvl,",4 Zv) W cn IA 36 4C Georgetown Court Apartments Application %r Power Pkm t and Heating, Coding, Ventilation, Re%ige- ation and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept, of Bias Phones se -UM GRA V*TY WARM AIR: RATE TOTAL Furnace Shell do Duct Work ;10.00 ; Replacement of Furnace 600 $ City of Fridley: Repairs & Alterations—up to ;500.00The undersigned hereby makes application for a permit for the work hereir 6 00 �- -- -- -specified, agreeing to do all work in strict accordance with the City Ordinance: Repairs & Alterations each add. $500.00300 =_ __ _ and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. MECK WARM AIIt Furnace Shell 3c Duct Work to 10,000 BTU x10.00 ;_ '� � Fridley, Minn i each add. @0,000 BTU ®a nwner Replacement of Furnace 6.00 ; Kind ,of Building ��-r 14 1 Repairs & Alterations ---up to $500.00 6,00 $L d aQ - Repairs &Alterations each add. ;500.00 3.00 ;_ Use STEAM or HOT WATER SYSTEM Furnace Shell & Lines --to 400 sq. ft. EDR Steam ?I0.00 Furnace Shell, & Line --to 640 sq. ft EDR Hot Water 10.00 Each add. 200 sq. ft. EDR Steam 3 on $ - Each add. 320 sq. ft. EDR Hot Water 3.00 S—_ ---- OIL BUPNER-to 3 gal. per hour 6.00 over 3 gal. per hour --See Fee Schedule GAS BURNER t up to 199,000 BTU) b,00 over199,000199,000 BTU See Fee Schedule GAS FITTING FEES. NO RATE TOTAL Ist 3 nxtures —_-- _ -- xa zoo E_... Additional Fixtures x .75 f.._-__ Gas Range to 199,000 — x$ 5,00 !.__�_ AIR CONDITIONING State Surcharge .50 i FAN HEATING ST51ZM S« F« Schedwe VENTILATING SYSTEM = ALTERATIONS A REPAIRS TOTAL TEE ; �� ✓� C? To he completed about Estimated Cost, $% U�.1 C' G_ C G Nd New. Building Permit No. Permit No. DE80UPTION OF WORK HEATING or POWER PLANIS-Steam, Hot Water, Warm Air—No- Trade Name._-- Size No /�C> Capacity � - - Sq.,h't. E.D.R L. BTU C Total ''onnected Load,� 21' Rind of Fuei; cL� cc BURNER -- Trade Na Size No Capacity__!._ Sq.5z1M.R__ BTU m. ROUGH FINAL //-/d - �� "" ✓/ / ---� . j (REMARKS—OVER) Pbone CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Now Fixtures $ 5.00 : Future Fixtures $ 3.50 $ Old opening, New Fixture $ 1.50 = Beer Dispenser $ 1.00 $ Blow Off Basin $ 5.00 $ Catch satin $ 5.00 $ Rain Mater Leader $ 5.00 $ Hydraulic Valve $ 5.00 $ Sump or Receiving Tank $ 5.00 $ Mstar Treating Appliance $ 7.00 $ Not Nater Neater $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance $ Reinspection lee $ State Surcharge $ .50 ($15.00) TOTAL FEE $ �;v StteCtLVe Aug. 1, IVUI Job Address ":2 _ Department of Buildings City of Fridley Tel. 0571-3050 The undersigned hereby makes application for a Permit for the lark herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Bu..ldings, and hereby declares that all the facts and representations stated in this application are true and correct G--=L3R Fridley, Ref. D KIND OF BUILDING USED AS A/ �" r c, y( 1 n n it TO BE COMPLETED ABOUT ESTIMATED COST h5 / <7 t 19 T3 OLD - NEW BUILDING PERMIT NO. PERMIT 110. P95� Company Signed By —� Tel. No. ROUGH INSP. Date FINAL INSP. b- - 2-? "KJ Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PE T IS $10.00 PLUS THE $.50 STATE SURCHARGE ya U N Nater �++ w a [ Neater �g 0.aq 14 49 o a1 w w •'Gi g a� n u n a u 3 yi s lac tn o lot 2nd 3rd 4th (R) - Future Connection Opening Connected with Sewer (�) - New Fixture, Old Opening Mater RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Now Fixtures $ 5.00 : Future Fixtures $ 3.50 $ Old opening, New Fixture $ 1.50 = Beer Dispenser $ 1.00 $ Blow Off Basin $ 5.00 $ Catch satin $ 5.00 $ Rain Mater Leader $ 5.00 $ Hydraulic Valve $ 5.00 $ Sump or Receiving Tank $ 5.00 $ Mstar Treating Appliance $ 7.00 $ Not Nater Neater $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance $ Reinspection lee $ State Surcharge $ .50 ($15.00) TOTAL FEE $ �;v StteCtLVe Aug. 1, IVUI Job Address ":2 _ Department of Buildings City of Fridley Tel. 0571-3050 The undersigned hereby makes application for a Permit for the lark herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Bu..ldings, and hereby declares that all the facts and representations stated in this application are true and correct G--=L3R Fridley, Ref. D KIND OF BUILDING USED AS A/ �" r c, y( 1 n n it TO BE COMPLETED ABOUT ESTIMATED COST h5 / <7 t 19 T3 OLD - NEW BUILDING PERMIT NO. PERMIT 110. P95� Company Signed By —� Tel. No. ROUGH INSP. Date FINAL INSP. b- - 2-? "KJ Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PE T IS $10.00 PLUS THE $.50 STATE SURCHARGE SUBJECT PER N City of Fridley o 18210 AT THE TOP OF THE TWINS BUILDING PERMIT f '-71 L R06. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 I � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 9/16/85 JOB ADDRESS 5700 EXKnXn1X East River Road N.E. 1 LEGAL LOT NO, BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 18 1 1 Aud.. Sub. #78 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lynwood Manor Nursing Home 5700 East River Road N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Four Saeson Construction Co., Inc. P.O. Box 32033, Fridley 786-4039 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Nursing Home 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑X ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Interior Alterations 9 CHANGEOFUSEFROM TO STIPULATIONS Screen dumpster in rear of parking lot with screening fence. Door #5 can not be a pocket door - must be 20 minute rated with closer. SEPARATE PERMITS REQUIRED FOR WIRING, HEATING, PLUMBING AND SIGNS. 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 SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 $4/200' $2.10 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 A HER STATE OR LOCAL LAW REGULATING CON- $50.50 TRU N O ERFO N F RUCTION. (� LAN CHECK FEE TOTAL FEE $32.83 $85.43 SIGNATURE OF CONTRACTOR A HORIZEDNT (DATE) WHEN PROPERLY V (DATED THIS IS YOUR PERMIT BLDG IN5R JOATE SIGNATURE OF OWNERIIF OWNER BUILDER$ (DATE) V� d F.rN�rf r ron I�u r-n,rr- �� _ � p ' ., IFW MWr ,I a Ffinv7atp.,=wttttl' J1°cr 4_� 6 li tYRF � rl b.�iidl.�-� t ._ 8 fE.� r, � ��� �' G'Yz7`.• i L r rXaaa 9 rrl•,..�q. .. ifl Cr„F- I�wkl�,r J U�W4"'JA77r»�I�ro^ .� _, . 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FYI I � r�r i✓J rC C("Wrfr r.. r J h t.ren`n"'. �h w/U..mamma_ v= ��Tkrynli.PN IIYJ.�r(' f.'r✓Cf"' lPF, �a ;^ uk,c nr r v nrxvrf= rrvr'YiYF,VMO,o c1p nr7Glr 2rvA1 IHrn.I Uh' df 44�R,1Mr,. ..---- f1�IYIFrJ hr r(+MNP�17 Mu+Af mW r. 6?, MavRu r�t°i7a k-c klJuntn, vn wMANY"P7kciu.n G� .._....___�__......_..... � �I�� w !X W Y4{ p T NFL f. �� iF:CT to Ew47"f ACa"h ISH YJFM ._._._....._...,,.. .l �I'��, I fXllW^R VNf,'w"� V(Nfy iN Nape J;.y„IurMf i:�7' .�IhW,� ( Ila lna nr"� 1� nrl� ✓rnr Vvuc. ��adY ta'f��r✓� E JIcrJa+p,.r �;37FA v wow�.;F <T N::r I �iPal��r Iro � � rFro �v�� r^✓"HovFr,��� � _ r�x� wsru,rt, ti�xa- a � nwl �e,rrr ��r r�� Mw race% d Prepaid Plan Check $ Estimated Cost $ Receipt # City Of Fridley R-3, COMMERCIAL & INDUSTRIAL Building Permit Application Effective 4/1/84 Construction Address: Eac, � .� = Valuation $ ) Legal Description: kO4 I ll AS = Valuation $ ) Cost/Sq. Ft. = Valuation $ ) Property Owner A Address: 590 0 .,+ Tel Contractor A Address: Y Tel. � Architect & Address: rr dt, Re g,# Engineer & Address: yDag [c�.-� Re # Reg. Type of Work [ ]New [ ] Addition [q Alteration E OF BUILDING: APPLICANT SIGNATURE: Tel. # Date:—`�cr7 BUILDING DIMENSIONS Size of Structure Length Width Height Sq. Ft. # of Stories OFC. AREA: Length Width Height Sq. Ft. WHSE. AREA: Length Width Height Sq. Ft. OTHER AREA: Length Ac.���911u�• Sq. Ft. X $ Sq. Ft. X $ Sq. Ft. X $ Width Height Sq. Ft. VALUATION Cost/Sq. Ft. = Valuation $ ) Cost/Sq. Ft. = Valuation $ ) Cost/Sq. Ft. = Valuation $ ) Type of Building ConstructionV ! Pr'L Air Conditioned [ ]Yes [ ]No Permit Fee $ _ 4so SO Plan Check $ �.53 State Surcharge $ Z.•1� SAC Charge $ Park Fee $ Sewer Main Charge $ Driveway Escrow ,#11�TDo �i Occupancy Group Class. Zoning Fire Prutection System [ ]Yes See Fee Schedule on Reverse Side Total [ ]No. In excess of Prepaid Plan Check -See Back Pg. $.50/$1,000 Valuation (See Sched. for > $1 mil) $425 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] TOTAL -E -r2 STIPULATIONS: 44XA A h CITY OF FRIDLEY BUILDING PERMIT STAFF REVIEW UMINNESOTA _ Date Received: Date Due: File No./Address: S?Go CCAsT- M `pH3 L MARK; CLY E ; ) Has Plans BOB J- 1. Planning - ' 2. Code Enforcement 13. Engineering 4. Fire 1 I 5. Police T 1 I 1 6. Code Enforcement R ; 7. Public Works Dir i Give Back to Planning DATE: j DATE: Building Permit Review VMg. ; 2nd Mtg W/Requester Req. —T DATE FILE REQUIRED INFORMATION: ROUTING APPROVED j LOCATION COMMENTS I I 1 Site Plan JIM Design Plan } DARREL + Construction Plan DARREL in , R.C.W.D. Approval (if nec.)i DARREL 8 i i i lT� �' .-��r+c i 9 fisc_,S/f'-�" r—�E4aoerc,fiGfr✓I`i MARK / Bonds Needed JIM A SID Easements: Bike/Walkway 1 CLYDE I 1 1 1 ,f Road i CLYDE �. Drainage I CLYDE I 1 1 Utility 1 CLYDE 1 1 1 Drainage Plan MARK j Landscape Plan j 1 JIM 1 1 j 1 EAW MARK ' FIRE DEPARTMENT j I BOB 1 I 1 POLICE DEPARTMENT j 1 JIM H. t 1 1 OTHER, LIST: DATE INITIAL ; COMPLETED ; STIPULATIONS 3/0/8/5/ Prepaid Plan Check $ Estimated Cost $ Receipt # City Of Fridley R-3. COMMERCIAL d INDUSTRIAL Building Permit Application Effective 4/1/84 Construction Address:_""tt�?iih Legal Description: j_o�t AS . 0-122 ., Property Owner A Address: 70 O Tel I. Y/D$ Contractor i Address:__ Do2w SOC �s�^ �i� IQp�r 3�03� Tel. (7 Architect A Address: E46L� ),0r %, Reg.# Engineer A Address:�-�v45 Reg. # Type of Work [ ]New [ ] Addition j Alteration E OF BUILDING: APPLICANT SIGNATURE: Tel. #7�� -y039 Date: BUILDING DIMENSIONS Size of Structure Length Width Height Sq. Ft. # of Stories OFC. AREA: Length Width Height Sq. Ft. WHSE. AREA: Length Width Height Sq. Ft. OTHER AREA: Length Width Height Sq. Ft. VALUATION Sq. Ft. X $ Cost/Sq. Ft. = Valuation $ ) Sq. Ft. X Cost/Sq. Ft. = Valuation � em ) = Q Sq. Ft. X $ Cost/Sq. Ft. = Valuation $ ) Total Type of Building Construction Occupancy Group Class. Zoning Air Conditioned [ ]Yes [ ]No Fire Protection System [ ]Yes [ ]No. Permit Fee $ See Fee Schedule on Reverse Side Plan Check $ In excess of Prepaid Plan Check -See Back Pg. State Surcharge $ $.50/$1,000 Valuation (See Sched. for > $1 mil) SAC Charge $ $425 per SAC Unit Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Driveway Escrow $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ STIPULATIONS: 5-7-5 10%W r,E, 1-5 -7 DO F. P-tJt� P -D, w s 9 y.6 l2 1. } s j ' O � e • b � 7b " LA (A - j 1f1 M s 9 y.6 l2 i O � e • " LA (A M City of Fridley suBJECT F21 9272 AT THE TOP OF THE TWINS BUILDING PERMIT f EIPT NO. • _____ COMMUNITY DEVELOPMENT DIV. L- - r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 11/17/87 JOB ADDRESS 5700 East River Road N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. Pt. 18 Auditor's subdivision #78 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Beverly Enterprises (Lynwood Manor Nursing HOm) 5700 East River Road N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Beverly Enterprises P.O. Box 1628, Fort Smith, Arkansas 72902 (501)782-8601 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. Same James Forberg 4028 Upton Avenue, Mpls. 9150 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Nursing Hane 7 CLASS OF WORK NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 31' x 20' Laundry Building 9 CHANGE OF USE FROM TO STIPULATIONS Dumpster to be enclosed with masonry Structure on three sides. Handicap stall in driveway entrance to be moved to a different area; preferrably first stall on north side of lot. See notations on plan. WAR X11 Before digging call local utilities TELEPHONE- ELECTRIC -GAS Etc. SEPARATE PERMITS REQUIRED FOR REQUIRED BY LAW Wir"!;"�.G, H—EA TNG, PLU".MSING AND SIGN& 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 SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING 1 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 ,r3g'300 $19.65 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT yY� DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $154/x.70 $412.35 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT[6 1 IDATEI EN PRO ERJc'y' A DATE THIS IS P��j � - /i fi 'O,UR �1 LL �TLlj1/J,'XTI / 1 l BLDG W5P DATE SiG TURE OF OWNERIIF NER BUIL FR ATEI Prepaid Plan Check $ Q�, Estimated Cost $ 6 sea Receipt # City Of Fridley R-3, ODMMERCIAL & INDUSMIAL Building Permit Application Revised 111/87 ODnstruction Address: %DCS 6Gn ,�2h Zoning: Legal Description: &44X27 �v,eaX iG .28' Property Owner & Address:' czjegz'T '7V 2 z Tel. #T- 02d' o! Contractor & Address: rhe_ d_ c�fiyreA/ /O -re -5 ��_ �Tel. # �f Architect & Address:.? t --s F .a �.Q f6�8 Via,-oma,^�U�. n -r .v�vx�,�Q.��Reg• # Engineer & Address Reg. # Type of Work [ ]New Addition [ ] Alteration��11-� -" _ USE OF BUILDING: APPLICANT SIGNATURE: _Tel. # Date: 0 1,3ez BUILDING DIMENNSIONS Size of Structure Length J/ Width _ ;�_o Height LG Sq. Ft. C�aO # of Stories - OFC. AREA: Length Width _ Height Sq. Ft. _ WHSE. AREA: Length Width Height _^ Sq. Ft. ^� OIIHER AREA: Length _y Width Height Sq. Ft. _VALUATION Sq. Ft. Z©_ X $ (,� Cost/Sq. Ft. = Valuation $ Sq. Ft. X $ Cost/Sq. Ft. = Valuation $ ) _ $ o Sq. Ft. X $ _ Cost/Sq. Ft. = Valuation $ ) Total Type of Const: Occup. Group: A/C [ ] Yes [ ] No Fire Prot. [ ] Yes [ ] No Performance Bond Amount $ See Reverse for Schedule Received [ ] Yes Permit Fee $ 12 40 See Fee Schedule on Reverse Side Plan Check $ In excess of Prepaid Plan Check -See Back Pg. State Surcharge $ $.50/$1,000 Valuation (See Sched. for > $1 mil) SAC Charge $ "-- $525 per SAC Unit Perk Fee $ Fee Determined ty Engineering Spec. Assessments $ Agreement Necessary [ ] Not Necessary [ ] Driveway Escrow $ feet at $13.50/foot STIPULATIONS: 11 S pn� . I o, S u -sieqM 41. SD 'Z .6U SUBJECT = CITY OF FRIDLEY, BUILDING PERMIT MINNESOTA REVIEW FILE NO. ADDRESS FILE DATE COMPLETE REVIEW CHECKLIST ,)o o�� RETURN TO BUILDING INSPECTION A) JDUE DA E JIM 'GCOMM 1ENT�Sy� `n C, hV � C -c +0 �, eno<` ,-,e- ` wIc, I LAck-�/` )CCS Llai -JOHN ��/-;��� v roved o_ c�,�c�-enA-- act . A,c -utl� 0,,-DARREL ?viior�i- �oe cp �--+ MARK all C1,10.6 , CLYDE F] LEON J POLICE (� FIRE BLDG. INSP J SUBJECT PER NO. City of Fridley 0 19292 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIP Ir � COMMUNITY DEVELOPMENT DIV. r i PROTECTIVE INSPECTION SEC. Y i i lr,.� CITY HALL FRIDLEY 55432 NUMBER REV DATEPAGE OF APPROVED BY L 612-571-3450 910-F15 12/1/87 JOB ADDRESS 5700 East River Road N.E. 1 LEGALLOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. Pt. 18 Aud. Sub. #78 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lynwood Manor 5700 East River Road N.E. 571-3150 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Re -Do Inc. 14201 W. 62nd Street, Eden Prairie, MN 55344 934-6026 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Nursing Home 7 CLASS OF WORK ❑ NEW ❑ ADDITION? ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Replace old windows with new windows:, Replace doors, Not changing openings 9 CHANGE OF USE FROM TO STIPULATIONS 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 SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 $15,0,00 000 $7.50 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 PROVISIONSAF ANY QTkER STATE OR LOCAL LAW REGULATING CON- $110.50 STRUCTIO TH PER MANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $118.00 Si EO ONTRACTORORAUTHORIZEDAGENT tDATU WHEN PROPERLY VA AFED THIS IS YOUR PERMIT 1gAT / SIGNATURE OF OWNER OF OWNER BUILDERI (DATE) - BLDG iNSP J Prepaid Plan Check $ T_ Estimated Cost $ Receipt # _ Gonstruction Address: Legal Description: Property Owner & Address:Upwax-4 Contractor & Address:k (�,) Inc Architect & Address: 1'16Y� YtsZ Engineer & Address. \\ City Of Fridley R-3, GDMMERCIAL & INDUSOUAL Building Permit Application Revised 1/1/87 Zoning: t%� I cmeQ,5�cx� E-�ve�e ►. d r� d_lee� . 5�Tiel . # lyzol U 2"='S �dp��r��r�� Mu 6Sfyy Tel. # vv- 60e6 Type of Work [ ]New [ ] Addition APPLICANT SIGNATURE: ,Reg. V6.�2 # ---- 1 \ \ Reg. # (�0o(2s Rgkk--ewteN [ ] Alteration Wkc VUSE OF BUILDI lVUC �j�M4 Tel # - Z �cw _____ 9 (4 BUILDING DIMENSIONS Size of Structure Length _ Width Height OFC. AREA: Length Width _ WHSE. AREA: Length Width _ OTHER AREA: Length Width _ Sq. Ft. _. Height _ Height _— Height — VALUATION Sq. Ft. -- X $ _ _ — Gost/Sq. Ft. = Valuation $ Sq. Ft. _ X $ Cost/Sq. Ft. = Val ua tion $ Sq. Ft. X $ -- Cost/Sq. Ft. = Valuation $ Type of Const: _ Performance Bond Amount $ Occup Group:''' A/C [ ] Yes [ ] No jo See Reverse for Schedule Permit Fee $� Plan Check $ State Surcharge $ SAC Charge $ _ �— Park Fee $ Spec. Assessments $ _ Driveway Escrow $ ZDV $ 1 1 S.W STIPULATIONS: # of Stories Sq. Ft. Sq. Ft. Sq. Ft. $_ Total Fire Prot. [ ] Yes [ ] No Received [ ] Yes [ ] No. See Fee Schedule on Reverse Side In excess of Prepaid Plan Check -See Back Pg. $.50/$1,000 Valuation (See Seed. for > $1 mil) $525 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] _ feet at $13.50/foot I S,cxw 0 Itb 'ig,od CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gas Range Gas Dryer NO. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance Reinspection Fee $ ($15.00 ) RATE $ 5.00 $ 3.50 $ 1.50 $ 4.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 State Surcharge TOTAL FEE TOTAL $2000 $ .50 $ 2-0.5'0 Effective Aug. 1, 1981 Job Address 577L G ,E7,;;f7 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. %lg OWNER L y U lduUd /�jfi livr '%• r KIND OF BUILDING /vn/4/S/ti USED AS .414,.,3 ?"hl � 1 TO BE COMPLETED ABOUT � ` 2 1' ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT INO. Company%y �/J(JQ/7 L_- / 4� L4' 43f,Y Signed By vLG� `�� Tel. No. J J -;7/zb (r ROUGH INSP. Date FINAL INSP. p2 '-' 1 I - F? Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00 PLUS THE $.50 STATE SURCHARGE m u4 Water A a yro4 ri •xi N U) U) y S4 C •,A U) A 4-) n, W C Heater W 4) � E m E .4 ro N UJ (d s4 W � k aa) N C x •.Ci I I G 3 O u •Oi 6� � u w O O •�1 4) U) I q U) •.4 � O O +4 N 41 ul m W al 4 +� En ro -4 U s4 D ro P7 ro M •H m ro S u o O W c U] r+ W m ro U M p rord.4 r� 3 0 £ ro 0 4, O 3as lec 1st r f 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gas Range Gas Dryer NO. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance Reinspection Fee $ ($15.00 ) RATE $ 5.00 $ 3.50 $ 1.50 $ 4.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 State Surcharge TOTAL FEE TOTAL $2000 $ .50 $ 2-0.5'0 Effective Aug. 1, 1981 Job Address 577L G ,E7,;;f7 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. %lg OWNER L y U lduUd /�jfi livr '%• r KIND OF BUILDING /vn/4/S/ti USED AS .414,.,3 ?"hl � 1 TO BE COMPLETED ABOUT � ` 2 1' ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT INO. Company%y �/J(JQ/7 L_- / 4� L4' 43f,Y Signed By vLG� `�� Tel. No. J J -;7/zb (r ROUGH INSP. Date FINAL INSP. p2 '-' 1 I - F? Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00 PLUS THE $.50 STATE SURCHARGE CITY OF FRIDLEY catectiVe Aug, 1, 1981 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE nvcynLmmTT i Furnace Shell and Duct Work, Burner (Also replacement furnace) Gas Piping (piping needed with new furnace) Gas Range Gas Dryer * Air Conditioning (all sizes) All Others/Repairs and Alterations 1% of Value of Appliance or Work COMMERCIAL/INDUSTRIAL 1% of Value of Appliance or Work nm 200 �1A.". State Surcharge TOTAL FEE Reinspection Fee ($15.00) Rough Insp. Date Final Insp. ?,-/ -FS, Date Approval for Permit USED AS+Q T��/ �&S 1!:1t!% E, $ -woo V . TO BE COMPLETED ABOUT ESTIMATED COST $ .50 •� OLD ,NEW BUILDING PERMIT NO. PERMIT NO. $ �D�J• s DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. / Trade Name JeC-ZA)&-A- Size No. r=x G �� Capacity IS lw&4. Sq. Ft. EDR BTU HP Total Connected Load Kind of Fuel /��Z BURNER - Trade Name Size No. Capacity Sq. Ft. EDR ppBTTU�U HP MINIMUM FEE FOR ANY HEATING PERMIT IS $10.00 Company /&41c. --;;ie_ PLUS $.50 STATE SURCHARGE Signed B Attach stack verification form with replacement furnace permits �� J / Tel. No J *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. iv; T C- /"'L .m . •.v g Job Address RATE TOTAL $ 20.00 $ Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 City of Fridley $ 10.00 $ Tel. #571-3450 $ 10.00 $ 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 $ 10.00 $ and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. $ 10.00 $ Fridley, Minn.'/n. ,, 19�( r w J��—+ OWNER �/V id� VAA�__7� dICy4 7-/i/ 69 7 �G NT .rs /fir $ KIND OF BUILDING W N C: J -r'95 State Surcharge TOTAL FEE Reinspection Fee ($15.00) Rough Insp. Date Final Insp. ?,-/ -FS, Date Approval for Permit USED AS+Q T��/ �&S 1!:1t!% E, $ -woo V . TO BE COMPLETED ABOUT ESTIMATED COST $ .50 •� OLD ,NEW BUILDING PERMIT NO. PERMIT NO. $ �D�J• s DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. / Trade Name JeC-ZA)&-A- Size No. r=x G �� Capacity IS lw&4. Sq. Ft. EDR BTU HP Total Connected Load Kind of Fuel /��Z BURNER - Trade Name Size No. Capacity Sq. Ft. EDR ppBTTU�U HP MINIMUM FEE FOR ANY HEATING PERMIT IS $10.00 Company /&41c. --;;ie_ PLUS $.50 STATE SURCHARGE Signed B Attach stack verification form with replacement furnace permits �� J / Tel. No J *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. iv; T C- /"'L .m . •.v g CITY OF FRIDLEY Effective Auq. 1, 19RI APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE .USIDIM?IAL RATE TOTAL Job Address 5-2oo i6, Fi Furnace Shell and Duct Mork, Burner !Also replacement furnace) $ 20.00 $ Department of Buildings 6 31 University Ave. N.E., Fridley, MN S5432 City of Fridley Gas Piping $ 10.00 $ Tel. 0571-3450 (piping needed with new furnace) The undersigned hereby waked application for • permit for the work herein Gas Range $ 10.00 $ �' specified aqreeinq to do all work in strict accordance with the City Codes Gas Dryer $ 10.00 $ and rulinqs of the Department of Buildinqs, and hereby declares that all the facts and representations stated in this applicatio"""n��� are true and correct • Air Conditioning (all sizes) $ 10.00 $ Fridl. . Minn. �j �'( /,Z— All Others/Repairs and Alterations OWNER It of Value of Appliance or Mork S RING OF orBUILDING /? COMMERCIAL/INDUSTRIAL USED AS 4 12 o 4t D� i� qo It of Value of Appliance. or Mork Sr TO BE COMPLETED Aiare ``11fX `U ESTIMATED COST 2 V State Surcharge $ .50 t c% OLD - NEW BUILDING PERMIT NO. vtttMIT NO. 70M )!EE $ /ALX pC } Reinspection Fee ($15.00) $ OFSCRIPTION OF rupNACt/sUlM1NER Rough Insp. Date/�� HEATING or POWER PNTS, Steam, Not Mater, Mars Air- No. �� �-� b t (ti-(, U P Trade Name size No. Final Insp.% C HP ate L — ?�b C / rl4'd Capacity S9. Ft. EOR BTUApproval for Permit A � (� � / — W74 Total Connected Load Kind of Fwl BURNER - Trade Natie Size No. Capacity Sq. Ft. EDR BTU RP MINIMUM FEE FOR ANY HEATING PERMIT IS $10.00 Compo^y �� J S��P-V)Cg-s PLUS $.50 STATE SURCHARGE Signed By Attach stack verification fors with replacement furnace permits Tel. Ne •Air Conditioners can net he placed in aaidv yard without. written purnission from adloininq neigld-or. SUBJECT City of Fridley WPER�"'� 19770 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT • _ COMMUNITY DEVELOPMENT DIV. -------PROTECTIVE r PROTECTIVE INSPECTION SEC. 107Q, 0 7Q CITY HALL FRIDLEY 55432 DATE PAGE OF APPROVED BY 612-571-3450 INUMBERREV. 910-F15 JOB ADDRESS '^ l 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. IsD UQ SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE S) GYM E_ R 5)1- 2))so —Lyucbc, 3 CONTRACTOR MAI A $$ ZIP PHONE LICENSE NO. V P�� cmc o COILS' w� .:,�- !Ssq q i 5 Z -q 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING S �E' 7 CLASS OF WORK Ye �-,/ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK 9 CHANGE OF USE FROM TO STIPULATIONS SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. I/-- THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. 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 l 1, WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 00 y DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE 6 SIGNATURE OF CONTRACTOROR AUTHORIZED AGENT IDATEI1 W N PROPE LY D T THIS IS YOUR PERMIT SIGNATURE OF OWNERIIF OWNER BURDERI IDATEIBLDG iNSP T OATE Prepaid Plan Check $ Effective 5/1/88 Estimated Cost City Of Fridley Receipt # R-3, CommmCIAL & INIXJsmm Building Permit Application �.. Construction Address: 7 LR4 Zoning: Legal Description: Property Owner & Address: 'RA )��C ��o (� Tel. # �7C 315 CONTRACTOR & Address:---,, LL C-- -el. -a - ct6d � Architect & Address • Reg. # Engineer & Address: - Reg.# Type of Work [ -View [ l Addition [ ] Alteration US OF BUILDING: Ok APPLICANT S IGNFIPURE : 'l Tel. # Date: /L BUILDING DIMENSIONS Size of Structure Length r 'Z ' Width o� I Height ( _ Sq. Ft. J o1 # of Stories OFC. AREA: Length Width Height Sq. Ft. WHSE. AREA: Length Width Height Sq. Ft. OTHER AREA: Length Width Height Sq. Ft. VALU TION Sq. Ft. X $ Cost/Sq. Ft. = Valuation $ ) Sq. Ft.X $ Cost/Sq. Ft. = Valuation $ Sq. It. X $ Cost/Sq. Ft. = Valuation $ ) Total Type of Const: Occup. Group: A/C [ l Yes [ l No Fire Prot. [ ]Yes [ ]No Performance Bond Amount $ See Reverse for Schedule Received [ ]Yes [ ]No. Permit Fee $�/� 1�. O(i See Fee Schedule on Reverse Side Plan Check $ — In excess of Prepaid Plan Check -See Back Pg. State Surcharge $ '7 $.50/$1,000 Valuation (See Sched. for > $1 mil) SAC Charge $ i " ' $550 per SAC Unit Park Fee $ Fee Determined by Engineering Spec. Assessments $ Agreement Necessary [ l Not Necessary [ ] Driveway Escrow $ feet at $13.50/foot TOTAL $ X STIRMPQ'IONS: lw SUBJECT d CITY OF FRIDLEY, BL"ING PERMIT ri MINNESOTA REVIEW COMPLETE REVIEW CHECKUST FIL/E2NO. ADDRESS FILDAITE RETURN TO BUILDING INSPECTION �cn� ri�;a�� DUE DATE 0- KAT DARREL M MARK A W L ON PO ICE FIRE\ rl BLDG" 4NSP MMENTS ORDER CONTRACT GORCO CONSTRUCTION CO., INC. F NUMBER: 10700HIGHWAY 55 SUITE' 2$0 F INANCE GORCO CONSTRUCTION CO., tWelnatter caned CONTRACTOR 1a directed to make the PLY M OUT H. M N. 55441 (� ( Q� I SOU following Improvements to the property of: DATE: ��-4� r 49 E DISPATCH NAME: � rQ r.n a. C 1iOME III, F -- ADDRESS: 5 7 0b pcl-.a � A BUS. # 571-360, o- +. CITY: �-%L *_T____"iMN� ZIP 3 oZ �' 6W6 �Net�su , MATERIAL r 1 ' SPECIFICATIONS DESCRIPTION GARAGE SIZE: �a �- : 00 STUDS: . ax4XZ� l�or' oc RAFTERS:c�x �X !�' �� � OC TIES: a )(1. X a4- "qgu - OC HEADERSLa) a x 0 X 8'(0" DM SHEATHING:, GARAGE. �r ��� �• ( V"ARDBOARD SIDING ROOF: - ( ) ALUMINUM SIDING St i �A < <' ! SiDE B ­ ( ) HORIZONTAL LAP SIDE EAVES: /a NOTE: END A END 6 ❑ PANEL DOOR END EAVES: ❑ AUTOMATIC DOOR OPR. S FACIA TRIM: 1 X (. + 1)(1 ROOFING: a2 AG # 21A—� SIDING: /;a ( ) CLADWOOD SIDING ( j CLADWOOD SHAKES OTHER ( V"ARDBOARD SIDING ( j PRIMED SHAKES INSULITE SIDING ( ) ALUMINUM SIDING (- ) WOODTEX SIDING ( ) BACKERBOARD ( ) HORIZONTAL LAP ( ) STUCCO MILLWORK NOTE: ❑ FLUSH DOOR -' ❑ PANEL DOOR ❑ AUTOMATIC DOOR OPR. ET -ELECTRICITY tLA U_ � HARDWARE � � WINDOWS � 8ERVICE DOOR )RANCH STYLE (_ )2'x6' `y1-� 6S STRETCH ( 1 (C 1 ( 1 1Vxr MASONRY BLDG. PERMIT VARIANCE SURVEY GARAGE SLAB aL4. X a,Q_ GARAGE APRON REINFORCEMENT _t (C) DRIVEWAY ^ GROUND PREPARATION WALK -PATIO -STEP — BUILD UP REEMMOVA SNS EXCAVATION _, RO`NiENTSS�ELi C!�r�� 'FOOTINGS C REMOVAL iT7`"LABA4 _ BLOCKS, UNDER SLAB — EXCESS DIRT _ REMOVAL _ BLOCKS, OVER SLAB 1) COUALe (, REMOV IFEBA1S WATEflPROOF^ BUSH OR TREE REtrIOVAI_J__ - 13ACKFIL L I -- CTHER GSA (SEE REVERSE SIDE OF CONTRACT FOR COSDITIONa P..EREOF) Alt e; o 151.1p, 1tP*1 4 (3,LDG. 5 7tro E Rt 5 Z R V LCE (2 o R D /1�Jsz FORTHE'S SUM OF 'L TERMS: � PURCHASE PRICE S 6 CASH: FIFINANCE: ACCEPTED AS SPECIFIED ABOVE: X 1 WUPCHASER SALESMAN This covirac; is subject to approval and ac -4, -tante by the General Manager of Gorco Construction Co. X Generai Manager DOWN PAYMENTS ► r� 62J BALANCE DUES "YOU THE BUYER MAY CANCEL THIS PU CHASE AT ANY TIME PRIOR TO MIDNIGHT C THE THIRD BUSINESS DAY AFTER THE DA' OF THIS PURCHASE- SEE ATTACHED NOTIC OF CANCELLATION FORM FOR AN EXPLAN TION OF THIS RIGHT." The above order is subject to. and acceptance We purchaser expressly limited to the terr, conditions, warranties and limitations appear, on the reverse side hereof. REVISIONS No. DATE eY G O R C O CONST. C C t TYPICAL FOUNDATION 3 DRAWN BYDG SCALE ,w ATERIAL CHK'D DATE DRAWING NO 4 /. 0-72 s TRACED APP'D 00/ � No ��s�►--slii:�� CARRIAGE BOLT, 6X6XlO REINFORCING WIRE -:� - t—SAND 10 FILL 0j,. oll 6' TYPICAL. SECTION REVISIONS No. DATE eY G O R C O CONST. C C t TYPICAL FOUNDATION 3 DRAWN BYDG SCALE ,w ATERIAL CHK'D DATE DRAWING NO 4 /. 0-72 s TRACED APP'D 00/ � No ��s�►--slii:�� L ON AFAR :R MAN Ih" SRO Kr R SO TH EY CO R N EP -5 STAND)W CORNER FRAMING FIGURE F NOTE LAP JO sNT Ar CORNERS CREAR WALL) - 12 - .' 7swE7x9 ON END. v H w Lf J.v(o' Ooosx spec. I Nora; NOTE; CED A R o 0. AEOWOOD PLATE 14- V-6106 -6/6(3(.*) DOOR, CUT 12,E-O"RED 1.9 -f'ATE S'TS DlRt =y OPLWIN6 3'Ar- oN 54 -AB N o TE. SELECT ONLY -ME STMIUATeST STUDS FtiR 51Dr- TRIMNERS_ ROUGX OPEN I N 6 S - S TUD IUK j •' r ra - 30 28 _ I X C TRUSS SR,4CING PLYWOOD I 2 l5# FELT 2X6 WALL TIES 240' tPICK IX6 COLLAR TIES BUTT ROOFING .t x$'� RIDGE BOARD' l . 1 48 `.CENTER WA LL TIES P,AFTERS 2X6 2^ 6 - I Y/OC.ONS [NfO.DATE •Y 4 6 tNo. 17aHF--e%xll DBL 2 X4 TC P; PLATES ' 2X4 GORCO CONST. CO. TYPICAL GABLE FRAh'I N&- DRAWN OY D C SCALE MATERIAL CHK -D DATE1_3�� -7? DRAWING NO 016 TRACED APP'D sueIEcr PERM.I NQ,.,.__ City of Fridley o 19782 AT THE TOP OF THE TWINS BUILDING PERMIT _ r RECEIPT NO. • _ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 3/ �3 7 1 � � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 1/20/89 JOB ADDRESS 5700 East River Road N.E. 1 LEGAL LOT NO.BLOCK TRACTOR ADDITION n SEE ATTACHED DESCR. pt. l8 Auditor' s � � #78 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lynwood Manor Nursing Home 5700 East River Road N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Socon Construction Inc. 9901 Xylite Street N.E., Blaine, MN 784-6910 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. James Fosberg Arch 13655 Oakwood Curve, Burnsville 9150 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Nursing Home 7 CLASS OF WORK ❑ NEW ❑ ADDITION C)I ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Remodel bath area's 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan SSpARATr PERMITS REQUIRED WIRING, HEATING, PL AND SINS. 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 SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION 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 $17,200 $8.60 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. =H9dXM $189.00 N/A PLAN CHECK FEE TOTALFEE .85 $320.45 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) VVH PROjLf T THIS IS YOUR PERMIT !_' G INSP DATE/ SIGNATURE OF OWNER (IF OWNER BUILDERI IDATE� �• ........--------.... .........�_..._._._.__ _._....... WXa r F P lF� F r r r ✓v _. 'ri.. .... r" s ,","�., ��,'� "c'r ,/p. �,". ✓6^. �,wr h..✓; ✓n v r; m^ r 6 .uw v u i I "i,. " r, rv,r^ ': ;�^/ /. ',,c.a � � � J , �..✓:,, ,yE fy"� ,.l' �x�,a my rfpll�a r� a.. j rP In �mn l t. V If j r — 41 ,�::h✓i .. 4,j,_ J.. Prepaid Plan Check $ Estimated Cost $ Receipt # City Of Fridley R-3, CommERCIAL & INDUSTRIAL Building Permit Application Effective 5/1/88 Construction Address: S 7p0 I45 +- 2; ��r ROccA Zoning: Legal Description: Property Owner & Address: L.3 ", t".6 a (�- " �L� C�� 2 C 4 �-� `� Tel. # CONTRACTOR & Address: So C41 Co,., 1cfU � `��1: t � � u� f�14 � 2 w`� del. # -7 �i © Architect & Address: JCvi3 Arc dReg. # 9150 Engineer & Address: Reg.# Type of Work [ ]New [ l Addition Alteration C, I\1/ <<,riC USE OF BUILDING: I APPLICANT SIGNMRE: Tel. # Date: BUILDING DIMENSIONS Size of Structure Length Width Height Sq. Ft. I # of Stories OFC. AREA: Length Width Height Sq. Ft. WHSE. AREA: Length Width Height Sq. Ft. OTHER AREA: Length Width Height Sq. Ft. Sq. Ft. X $ Sq. Ft. x $ Sq. Ft. x $ VALUATION Cost/Sq. Ft. = Valuation $ ) Cost/Sq. Ft. = Valuation $ Cost/Sq. Ft. = Valuation $ o� _ $ 17, 2.0 0 Total Type of Const: Occup. Group: A/C [ l Yes [ l No Fire Prot. [ ]Yes [ ]No Performance Bond Amount $ See Reverse for Schedule Received [ ]Yes [ ]No. Permit Fee $ See Fee Schedule on Reverse Side Plan Check $ (2 L g� In excess of Prepaid Plan Check -See Back Pg. State Surcharge $ % $.50/$1,000 Valuation (See Sched. for > $1 mil) SAC Charge $ _576` $,5 per SAC Unit Park Fee $ Fee Determined by Engineering Spec. Assessments $ Agreement Necessary [ ] Not Necessary [ l Driveway Escrow $ 715� feet at $13.50/foot TOTAL $> STIF[JLPQIONS- �� ►t r`s !lJU ►��s C� �U ��-J� ll,. a I �1l:cfj SUBJECT CITY OF FRIDLEY, MINNESOTA COMPLETE REVIEW CHECKLIST RETURN TO BUILDING INSPECTION L 9A I M ffm I ly/ in -.-JOHN 'ra-DARREL POLICE FIRE 3LDG.INSP BUt.DING PERMIT REVIEW FILE N0. ADDRE [FILE DATE 17 ions"q6� �/)UE DAT 1 COMMENTS In CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures ( $ 5.00 $ N $ 3.50 $ Old Opening, New Fixture m 1.50 $ b $ o Blow Off Basin X a) Catch Basin Water 5.00 $ N ul 5.00 $ Hydraulic Valve $ N C a U) 0 Water Treating Appliance N a, W C 5.00 $ Heater a V .-4 $ u) Back Flow Preventer Required. E .i ro N $ m ro Sr (y 1% of Value of Fixture or Appliance $ -.r W P a) a) U) ro r .0 G U)ii a G r a) 3 N O .0 r u •A V 6 a) o C V O N N () O 41 to 0 O ro '4 U u a N ro RI U) ro co -A cn U) ro M .i :1 u o Q G. O .c En O -4 W U) ro ro U M U) y ro 3 rn ro l7 ro U .0 " O as lec 1st I 2nd 3rd 4thr I (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures ( $ 5.00 $ Future Fixtures $ 3.50 $ Old Opening, New Fixture $ 1.50 $ Beer Dispenser $ 4.00 $ Blow Off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ Hydraulic Valve $ 5.00 $ Sump or Receiving Tank $ 5.00 $ Water Treating Appliance $ 7.00 $ Hot Water Heater $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ Back Flow Preventer Required. . . Yes ( ) No ( ) Type $ 5.00 $ ALL OTH1."'S AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance $ State Surcharge $ Reinspection Fie $ - ($15.00) TOTAL FEE $- .50 Effective Date May 1, 1988 Job Address Sac) ��} �CfIUtYZ r,b? 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.(: , 19 OWNER L tj (�jpp�qq &,A, I )q, 0 A tz..e KIND OF BUILDING hh �ii 3� L4':t USED AS ISA U ate✓ TO BE COMPLETED ABOUT ESTIMATED COST is�0 Jll OLD - NEW BUILDING PERMIT NO. PERMIT NO. /�) pL/(� --T ROUGH INSP. Date Company Signed By L)"�1 � �t1 =j Tel. No. 'q41 —421°6 2 FINAL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE CITY OF FRIDLEY Effective Date May 1, 1988 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Job Address 6-700 -RESIDENTIAL RATE TOTAL Furnace Shell and Duct Work, Burner (Also replacement furnace) $ 20.00 $ Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 City of Fridley Gas Piping $ 10.00 $ Tel. #571-3450 (piping needed with new furnace) Gas Range $ 10.00 $ 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 Gas Dryer $ 10.00 $ and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. * Air Conditioning (all sizes) $ 10.00 $ Fridley, Minn. ��l_ 5' 19 All Others/Repairs and Alterations OWNER 1% of Value of Appliance or Work $ Tl/`/C,? l ST©'2 '-/ [� KIND OF BUILDING 4!�Fk15 COMMERCIAL/INDUSTRIAL USED AS /V& de 5 Z 1% of Value of Appliance or Work $ TO BE COMPLETED ABOUT% ESTIMATED COST ;%, State Surcharge $ .50 . OLD - NEW BUILDING PERMIT NO. PERMIT NO. -A�y���5�f TOTAL FEE _ $ Reinspection Fee ($15.00) $ DESCRIPTION OF FURNACE/BURNER Rough insp.HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Date Final Insp. l ! �/ Trade Name Size No. Date Capacity Sq. Ft. EDR BTU HP Approva Total Connected Load Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00, CompanyAID� PLUS $.50 STATE SURCHARGE Signed By 2 Tel. No. *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. Fill out back side for stack verification on replacement furnaces e.::— z swL.un L. _--RR wHlas= oL o f I 0 is- 6LIfP� x V.'S �'= -- -1 -- ZZL BOILER \ I �rvr sTOR_ - Lou II a 1 12 11 �3�ya MA DAY ROOM Eo-r.11 Do THF Fk vloE I Qow�� _ ;KI.asN11JG a•81 . ARcuNo aJcr - � w Q� <w BASEMENT HVAC PLAN I �F o0 SCALE-1/8=Y-0" L_L _ ---- �J-I TI H Via` 2 IIS 3 FM �ti9� w QZ 5 co r r a E I-I E, —- -I__ p. G M U rvoRT I SOIL.LINEN '' � i. � W Ld Lij �. =7� ,SS'lO KroF of611 t1 As- ST- Q r7 EE Derav,p1 sAC rtz--.___ =O OCCUR.T-ARY II F— r BAUTY 4 E J d }¶I I LL, Q zL A, z�,�� 2 /."�P4R 5/ Of00%R3 > oe I o T� _ OIL HERAPY _ 1 (1 —' -iF 'Z p- STOR L rJEN PMTS T L Z__-.t02 _-..-_.._- .._.-__.. O6 1 tOB _.._--.. ._-_ _- ^. , J 4 loYv1 � -tom .I TL /b�115 M I8 10 ll �-F STAIuLex STEEL 11 ,S \A�nS - OY3I4W/91ER ExNAUS1}eyy�3,AFM g'GFM SEE f7E(pILS OF SI'If M-Z 3 GFM IZ1�Ic11 IZ^bl1 310-3b"•I6i1 DEEP --._ n .,, _� r r f �- IZ�Ic Y � IDd�lo IDrlo IOu'(o ISS-10� "�G, GM f 2�M Ot� 0e .. ... 105=- 10 L 0, 1.., DIET OFF CE A c ` \ u� 2 � LFM OFFICEL ADM N. (ou KocF) e -, ouFl�) cuKa eooF�IDE Is�� _N" �L M 1bo AP^OlIIJD DOLT ll k .. ,. .I s-T R. TISLo1+�N DiNiNG _ ENTRY - -41- p j! C _ OFP ICE \z- Z Al EF '.� � � G.IrzT/2/ONy LboFS � In NE,. ErJIJJLs? FAI.,�E F-ii To ® Nr'ROVIOE 4'^4 KEDWOpG SSPfb KTS tIWDER MA#-�° r BE MollIJ1FA C�%Ent5rlllc, KITGHEF �j,`U,ti,ST HAD- Z AIK 111JITs AfJL J KtXP GUK�„p10oIFY Exls(I IJ4 71_ao �`_�+r z'-r'PEEP, -1-f Fl1KlIP.C.L°. 511 K7S Am `-F LffK AS KEQHI�ED. PROVIDE A.(1If PLETE AIJ`�uL r-101 A IL t 6 MOP(�o IIT'eP(BErW E YtJAMi: IS�T ORS F U FIFg ttl ue.UN,4W4 5YSTEM. ,y 5H/'-LL 6C IaSTn.LLED P.EIWE EIH sllfi'bFTs = O�TlE �F11 T'-> r^IE11Tiot(ED E r Q MAIN FLOOR HVAC PLAN __ SCALE t/8•'=r-0" SCHEDULE OF DRAWINSS M-1 HVAz�FLAN5 Fq M-2 ME`HAUICA-X.HED' F-1 G Pm Ls - ELEt-1FI;ALRWNS E DETAILS GOMMISSIOn 04-889f ')li I Adwa MERSIONS WITH USED b Ml.v. OL i IG T ] L O.A. N dAL A R ENTERING/R VAP. p.PE SOA 'S-9: FN� n V DES IG. ?YPE ..M CFM S CAPACI.Y fCONO. 'EMP. REFR., L..MPS -.MPS LR.".MPS J NL NNP SPEED STARTER FILTERS MFG.N0. al I.LNNO%MODL CAA 1 COMPLETE W/RMF 15 a5 ROOF LUR3,_M0H15M HORIZ ECO40n(YER, PKG. EL. CONTA[N ED 2' IS 14 FILTER S C ION HARD START III,tIMEO JFF COMPRESSOR CONTROL.CQ4DE US ER COIL RT-1 DIREC DRI lE BLOWER Ifi00 900 9 Si_ Ny,p00 105 90i 51 R-22 - 30.0 2.2 2Cfl 60 3/4 MED. R-1. PLEATED GUARDS AND 2 STAG OOLIN6 STAT WITH SUG-BASE. L�NNO%MOD LL C A I'311 COnPLETE'.!/RMF-15-65 R.OF CDPD,REMD15 EC..OM Ic EA.HAa0 PKG SE..F'S__ IHcp 2" START KIT,TIMED�F.COMPRESSOR CONTROL,CONDENSER CDIL GUARDS,ANO 2 STAGE Df PEC'DPIfE BLOWER ]O00 250 L_1 29,000 105 .111 1-22 15.1 11.3 4.5 1. 1 60 1/3 HIGH 1— PLEATED COOLING STAT Wf H LUE-AASE. N p �tE XXN FVIMSrT�ELLED W 0 ECCNNTRKiOR. SITES PROVIDE A SUMMER/WINTER SWITCH'0 KI'C'HEN'G CONTROL NTS o N OCK BETWEEN aF-1 AND DF-I OR COOL LNG CYCLE. - ¢Q ROTE: I MNJUI.1. REOUIRNNG Rn UNITIURER BEFORE BEGIRRIRG IRSTLLLITIW.f1 IS OWMEP R O O F T O P M A K E U P A I R 'J 4 I T =DOL E (OWNER FURNISHED) D.NMIED'COR.t SH L RE MIS) H ISI fUWi'KES IGAU BE RESTORED O pi1Gl R/.L CORDIT ION, NIN FS TNG TOTAL O.A S NAL ;IR COND. UNIT DETAIL DESIG. TYPE M S NG=ATF F )T D. KE-UP.FIRED DRAYO-HASTINGS MODEL AMUA-600 RB COMPLETE H A INTAKE H000'W/BIRD 5CRE E4,AEMO'E CONTROL PANEL,OUTSIDE MU-1 MAKE-UP R13 UN LF 2450.2450 NG WOD NBH G MGH 4 GGO 2„8 _W Ii50 OY=�C' LEAicD AIR SHUT-OFF DAMPER W CONTROLS /IBRAT:ON ISf nTORS GRAVITY"EMT AND 409 SS HEAT�XCHANGEk �'¢ 0 'No1,EC -1 REO NL UM IY IZ EU i�L DRAV O-HAS.-INGS MODEL IMUA-160-RB COMPLETE W/F.ESH Ala INTAKE HOOD W/BIRD SCREEN,REMOTE LUNIROL PANEL,OUTSIDE E MU-2 0.KE UP AIR UNIT 100 350 0.50 PIG fW MBN 120 MBN N[BBON 12a PLcAT:'.D AIR SHUT-OFF DAMPER W/CONTROLS,VIBRATION ISI.?TORS,GRAVITY VENT AND AGR 35 HEAT EXCHANGER W RE R •Af` -- 2 D U C T F U R N A C E S C H E D U L E (OWNER FVRN iSHED) ` a JRIbIT f� " fv►-�'4yrry I xEAT IN6 U� My a 'Y PE FUEL FIGI-'All NET GUTPUT BURNER TYPE MFG.N0. S Y'N�iMY S FIRED ALJM IN I ZED S"EEL DRAVO-HASTINGS MODEL ROG-250 COMPLE'E W/409 SS NEAT E%CNAN6 N RAV TTY Yc ANT, 'JC FURNACE NG 250 MOH 190 MOH RIBBON MODUS NAP GAS VAL'fE FOR NA KE JR AfR APPLICATION Nip TIME OE LA RELAY:AN CONTROL :L OI ST yd:(RI,N YYR • - H A N A U ST SC H:D I L E % F STATIC MAS.FIP FRN o N R NgTOR EACKDRRFT T '_E SI G. TYPE LFN PRESS. SP ED RP,Y V H LIZ 'P 1 SITER PAMPER CURB M G.ND ROOF MOUNTED GREEN'ECK MODEL CUBE-21-/ .F-1 CENTRI NGAL UPoUST 2150 G 7 0533 910 200 LAID 3W GYBIND SCREEN EF-2 CFIITR IFUGAI 900 O.]>5 3X15 131C 111 1 60 1/0 S E GRAVITY GAL IANI<EOESCaE�EOEI 6'tl-1D-4 G DETAIL ' C 1 G C H E 9 D L- -W FURNI EO'. OWER A. AN6 Y ,TEN T:IR 'OiAI ,EAT N6 AMPS I.ONTROL TOTAL GAP. AMPS Y NZ MFG.NO. kU- N C EATEi 330 5 XW ( 1,5 PACKAGED 15000 BTUN 11.0 208 Fi 60 STANDARD STAMP U CEEL I.OUV ER oinensiaKM PU-NE- ZONcAIRE CSM I I`COMPLLT�Wj AC-.2 WALL PLEATED 330 1.5 KW /.> 2AC TAG ED 11500 8NH ].1 208 1 60 STAN CARO STAMPED STEEL LOUVER FO rn HRU-i NE- �' LONEA IRE CSM 1083 COMPLETE':( 2 'AC-. WALL PI.TA'ED 60 31p 1.5 KW ].5 PAG KAGED 1800 STUB 4.5 208 l 6O STANDARD SI'AMPFD STEEL LOUYER CU Q m AA O REI IST IA AND B RILLS SC H D U L E QUADRANT SECTION DES IG. TYPE NECK SIZE DAMPER MFG.NO. REMARKS L D-1 EXTRUDED ALUMINUM 21"N 21" I O.B.D. CARNES MODEL SALA 40 OFF-WHITE FINISH 0-2 EXTRUDED ALUMINUM 12"S 12" O.B.G. CARNES MODEL SAFA 20 OFF-WHITE FINISH Uj H 0-3 EXTRUDED ALUMINUM 9"% 9" O.B.D. CARNES MODEL SAGA 20 OFF-WN ITE FINISH z 1-1 DUCT MOUNTED SUPPLY 16"x E"t O.G.D. I CARNES MODEL RTDAH OFF-WHITE FINISH LLJ 1-2 DUCT MOUNTED SUPPLY 1G"x ". O.B.p. •CARNES MODEL RTDAH GFF-WHITE FINISH U R-3 DUCT MOUNTED SUPPLY 12"X 6" O.B.D. CARNES MODEL RTDAH OFF-WHITE FINISH G-1 EXTRUDED ALUMINUM 22"%22" - CARNES MODEL SPPA FRAME NO.2 OFF-WHITE FINISH Q Q G-2 E%TEDGED ALUMINUM IR"X IM" - CARNES.MODEL SPPA FRAME NO.2 OFF'AHI iE FIN ISN U Q aar N G-3 DUCT MOUNTED RETURN 30"S 8" - CARNES M00EL RSCAN OFF-WH[T'c Ff N ISH F' J P DG-1 ODOR GRILLE IE"% 6" - GARNES n00E1 RGHAO OFF-WHI iE FINISH QW DO W In 011-111D, E, lJ Y �. vt v+(I "OFT JF F t r t Rr I, TOTAL Rema rk s Company Signed By Da to C' CHIM14EY 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 connected Yes ( ) No ( ) 6. Has Total heating BTU's of All other BTU's TOTAL Rema rk s Company Signed By Da to C' CITY OF FRIDLEY Effective Date May 1, 1988 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE 4ESIDE1yTLAL Furnace Shell and Duct Work, Burner (Also replacement furnace) Gas Piping O/v4--'/ — (piping needed with new furnace) Gas Range Gas Dryer RATE TOTAL Job Address 5700 East River Road $ 20.00 $ Department of Buildings. 6431 University Ave. N.E., Fridley, MN 55432 City of Fridley $ 10.00 $ 15 minimum Tel. #571-3450 fee $ 10.00 $ 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 $ 10.00 $ and rulings of the Department of Buildings, and hereby declares that all the * Air Conditioning (all sizes) $ 10.00 All Others/Repairs and Alterations I$';of Value of Appliance or Work COMMERCIAL/INDUSTRIAL 1% of Value of Appliance or Work State Surcharge TOTAL FEE Reinspection Fee ($15.00) Rough Insp. Date Final :Insp. Date Approval for Permit MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00 PLUS $.50 STATE SURCHARGE *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. facts and representations stated in this application are true and correct. $ Fridley, Minn. November 16 , 19 89 OWNER Lynwood Health Carp Centpr $ KIND OF BUILDING Rest Home USED AS $ TO BE COMPLETED ABOUT T)eCPTl1'1PY 12, 1989 ESTIMATED COST _2F 5 n n nn $ .50 f(,U� OLD - NEW BUILDING PERMIT NO. PERMIT NO. $1 S_ sn DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Total Connected Load Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Company P & D Mechani Signed By Tel. No. 533-2218 Fill out back side for stack verification on replacement furnaces 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 connected Yes ( ) No ( ) 6. Has Total heating BTU's of All other BTU's TOTAL Rema rk s Company 5,gnev By Date SUBJECT PERMIT NO. City of Fridley 2069 0 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. � • _ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r � � CITY HALL FRIDLEY 55432 �""-'��� �•� NUMBER REV DATE PAGE OF APPROVED By 612-571-3450 910-F15 12/11/90 JOB ADDRESS 5700 East River Road N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. Pt. 18 Auditor's Sub. #78 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lynwood Healthcare Center 5700 East River Road N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Four Season Construction Co. 7855 Quincy St., Spring Lk Pk, 55432 786-4039 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Health.Care Center 7 CLASS OF WORK ❑ NEW ❑ ADDITION Ek ALTERATION O REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Install wall (10' x 8'•) with 3' x 6'8" Door for Office Area 9 CHANGEOFUSEFROM TO STIPULATIONS Post handicap parking sign. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 $ 350 $.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRIES E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS NY O R STATE OR LOCAL LAW REGULATING CON- $15.00 STR TION R HE RF OF CO TRUCTION. �. PLAN CHECK FEE TOTALFEE /�--- C $ . 3 5 $ .85 WHENPROPERLY V I H S YOUR PERMIT�n, SIGNATURE OF CORACTORO HORIZED AGENT IDA!Er -7- SIGNATURE OF OWNERUF OWNER BUILDERI SIGNATURE SP DATE Prepaid Plan Check $ Effective 8/16/90 Estimated Cost $ CITY OF FRIDLEY Receipt # R-3, C1200RCIAL & EMUSTRIAL Building Permit Application Construction Address..s �Zoning Legal Description Owner & Address" Tel.# aNMC'IOR & ADDRESS Tel. # � Architect & Address C� 2c A_� , ,,�- (y " /� Reg. # Engineer & Address # TYPE OF WORK [ ] New [ ] Addition (] Alteration -Describe_, Applicant Signature, Tel # Date Length Width Height Sq. Ft. # of Stories OFC. AREA: Length Width Height Sq. Ft. WHSE AREA: Length Width Height Sq. Ft. O= AREA: Length Width Height Sq. Ft. VALUATION Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) _ $ Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) TOTAL VALUE Building Use 1',azSi. Construction Type Occupancy Group Air Conditioning []Yes []No Fire Protection Provided []Yes []NO Performance Bond Amount $ See Reverse for Schedule Received []Yes Permit Fee Fire Surcharge Plan Check State Surcharge SAC Charge $ /600 $ $ ter-- -- $ SO s Park Fee $ Spec. Assessments $ Driveway Escrow $ TOTAL $ []No See Fee Schedule on Reverse Side .001 x Permit Valuation (1/10th %) In Excess of Prepaid Amount - See Reverse Side $.50/$1,000 Valuation (See Sched. for > $1 Million) $600 per SAC Unit Fee Determined By Engineering Agreement Necessary [] Not Necessary [] feet x $13.50/foot ITICINAL STIPUI14TICt4S CST REVERSE SIDE CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures - $ 5.00 $ Future Fixtures $ 3.50 $ Old Opening, New Fixture $ 1.50 $ Beer Dispenser $ 4.00 $ Blow Off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ Hydraulic Valve $ 5.00 $ Sump or Receiving Tank $ 5.00 $ Water Treating Appliance $ 7.00 $ Hot Water Heater $ 5.00 $ 5.00 Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ Back Flow Preventer Required. . . Yes( ) Ido ( ) Type $ 5.00 S ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance $ Reinspection Fee $ State Surcharge $ 50 ($15.00) TOTAL FEE $ 1 � _ Sn Job Address Lynwood health Care 5700 East River Road 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 720, 000 and rulings of the Department of Buildings, and hereby declares that all BTU the facts and representations stated in this application are true and correct Fridley, Mn. __ January 24 , 1992 OWNER Lynwood Healon Care Center KIND OF BUILDING USED AS Nursing Home TO BE COMPLETED ABOUT 1/31/92 ESTIMATED COST $5,500.00 OLD - NEW BUILDING PERMIT NO. PERMIT NO. ROUGH INSP. Date Company Bredahl Plumbing, Inc. l� q Signed By Tel• No. 612/ 24-2646 FINAL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE m �. m •ro u X a) Water 01 m m .A 4 C -Hm O ar 14 w [T c Heater v +j >4 v •-r 10a Fy m m E. •� ro x aj s, a) m ro a H v m C •.+ r r 3 W .c c O y a N 0 0 .0 4j m .X C ,C m •a 7 0 O 0 U .+ + m u m` m u m m c +J s+ ro ro ro sao x 0rocro ro f ro 41 cn r+ U :D m m cn 3 Q [' En [-. U M Q :.c U 0 O 3as lec 1st X 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures - $ 5.00 $ Future Fixtures $ 3.50 $ Old Opening, New Fixture $ 1.50 $ Beer Dispenser $ 4.00 $ Blow Off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ Hydraulic Valve $ 5.00 $ Sump or Receiving Tank $ 5.00 $ Water Treating Appliance $ 7.00 $ Hot Water Heater $ 5.00 $ 5.00 Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ Back Flow Preventer Required. . . Yes( ) Ido ( ) Type $ 5.00 S ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance $ Reinspection Fee $ State Surcharge $ 50 ($15.00) TOTAL FEE $ 1 � _ Sn Job Address Lynwood health Care 5700 East River Road 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 720, 000 and rulings of the Department of Buildings, and hereby declares that all BTU the facts and representations stated in this application are true and correct Fridley, Mn. __ January 24 , 1992 OWNER Lynwood Healon Care Center KIND OF BUILDING USED AS Nursing Home TO BE COMPLETED ABOUT 1/31/92 ESTIMATED COST $5,500.00 OLD - NEW BUILDING PERMIT NO. PERMIT NO. ROUGH INSP. Date Company Bredahl Plumbing, Inc. l� q Signed By Tel• No. 612/ 24-2646 FINAL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 572-3604 "AOL' nn IRAMCM nG G1VT1 iaFc Tr1 RF INRTAI I Fr) nN FACH FLOOR Water Stories Closet Urinal Bath Tub Shower Wash Drink. Floor Catch Auto. Gas Gas Misc. Water Heater Sink Tray Fount. Drain Basin Washer Appl. Range Fixt. Gas Elec Basemen The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $ 4.00 Floor 1 Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts Floor 2 __ $ 7.00 and representations stated in this application are true and correct. Catch Basin Floor 3 Rain Water Leader $ 7.00 Floor 4 Sump/Receiving Tank __ $ 7.00 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 5700 East River Road (Lynwood Health Care Center) New Fixtures $ 7.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin __ $ 7.00 and representations stated in this application are true and correct. Catch Basin $ 7.00 Rain Water Leader $ 7.00 June 4 , 199 Sump/Receiving Tank __ $ 7.00 Water Treating Appliance $10.00 Owner Lynwood Health Care Center Water Heater -Electric $ 7.00 Water Heater - Gas 1 $10.00 10.00 Building Used As Nursing Home Gas Range $10.00 1 Gas Dryer $10.00 Estimated Cost 2.200 PERMIT NO. Back Flow Preventer Required ( )Yes () No Type $5.00 PLUMBING COMP�fY � ahl Plumbing, Inc. Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance 10.00 State Surcharge $ .50 SIGNED BY. TEL N0, 424-2646 Approved By Rough -In Date Final Date MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 TOTAL FEE $ 15.50 PLUS THE $.50 STATE SURCHARGE SUBJECT City of Fridley 215 �92 AT THE TOP OF THE TWINS BUILDING PERMIT i RECEIPT NO. COMMUNITY DEVELOPMENT DIV. _ r 1 PROTECTIVE INSPECTION SEC. O S NUMBER REV. DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 �""'�", 612-571-3450 910-F15 10/6/92 JOB ADDRESS 5 700 East River Road NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt 18 Aud. Sub. #78 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lynwood Manor 5700 East River Road NE 571-3150 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Quarve Exteriors 8317 Monroe St NE, Spring Lk Park 55432 785-1472 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING RX Nursing Home 7 CLASS OF WORK ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK New windows & door; handicap door; 251 x 21' Patio; 6' x 30' Handicap ramp 9 CHANGE OF USE FROM TO STIPULATIONS WARNING Before digging call for all utility locations EPARATE PERMITS REQUIRED FOR454-0002 REQUIRED BY LAW (RING, HEATING, PLUMBING AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 $20,000 $10.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $207.00 Fire SC $20.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $134.55 $371.55 HE PR ER Y VAL ATED THIS IS YOUR PERMIT SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) \ /O_6 -- LOG INSP )ATE SIGNATURE OF OWNER IF OWNER BUILOERI IDATEI Prepaid Plan Check $ Estimated Cost $ Receipt # MY OF FRMtEY R-3, OOMIIRQAL & INDUSTRIAL Effective 1/1/92 Construction Address C� 9 6-) `t' A y L '(i VC: f}Q �(� b 1 e rt nl, Zoning Legal Description IF H S -1-t ? 6 1 Owner & Address L�, w �i �`, ^� 2 'J ' o, C �� Tel . # CONTRACIC R & ADERESS Qy AA/ �- N C* 7 Telj.. # ? c$ Architect &Address 5T, L K fk , PA ^ S Y X13 `-- Reg . # Engineer & Address TYPE OF WC W [ ] New [ ] Addition Alteration -Describe (,�! Y, O c r j G�c1?J� �-kow,Q C-L'w o(� 2 S zi t F? �fi` 1+�-f1l'C/9P ` i 7 Z Applicant Signature" " ( Tel # % S Date - Z � ` Z BUIIDIlW. DII4ENSICNS Lerrth Width Height Sq. Ft. # of Stories OFC. AREA: Length Width WHSE'AREA: Length Width aMM AREA: Length Width `TAIIPMCN Height Sq. Ft. Height Sq. Ft. Height Sq. Ft. Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) Sq. Ft. x $ Cbst/Sq. Ft. = Valuation $ wz� ; C10 Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) TEAL VALUE Building Use Construction Type Occupancy Group Air Conditioning []Yes []No_ Fixe Protection Provided []Yes []No Performance Bond Amount $ See Reverse for Schedule Received []Yes []No Permit Fee $ See Fee Schedule on Reverse Side Plan Check $ ` S In Excess of Prepaid Amount - See Reverse Side Fire Surcharge C CI .001 x Permit Valuation (1/10th o) State Surcharge $ $.50/$1,000 Valuation (See Sched. for > $1 Million) SAC Charge $ $700 per SAC Unit (Plans to HW0C for determination) Park Fee $ Fee Determined By Engineering Spec. Assessments $ Agreement Necessary [] Not Necessary [] Driveway Escrow $ — feet x $13.50/foot TUTAL $ 3Z-.00 L40 etc t._ADDITICNAL STIPULMCHS CH REVERSE SIDE Minnesota Department of Health Health Resources Division 393 North Dunlap CTP.O. Box 64900 St. Paul, MN 55164-0900 (612) 643-2100 October 2, 1992 Ms. Judy Cline, Administrator Lynwood Health Care Center 5700 East River Road Fridley, MN 55432 Re: Patio, Window Replacement, & Miscellaneous Remodeling for Lynwood Health Care Center, Fridley Anoka Co. PLAN FILE #431 Dear Ms. Cline: We have reviewed the building plans with notations received by FAX on October 1, 1992 for the above referenced project, which consists of door/window replacement, footing extension and patio, and front entrance modification for handicapped access. The proposal is acceptable to this Department contingent upon inclusion of the items detailed below. A. The following items were noted pertaining to Minnesota Depart- ment of Health regulations for State licensure of nursing homes: 1. The footing extension from the existing dayroom must be properly tied in to the existing footing and be sized appropriately. 2. Provide a sidewalk slope not exceeding 1:20 at the front entrance. 3. Provide detailed plans for the 3 -season porch and the new windows on the east wall of the day room prior to undertaking this work in the future. B. The following items were noted pertaining to compliance with the Life Safety Code (NFPA No. 101, Ch. 12, 1985) , which is required for Federal certification under the Medicaid and Medicare programs: Provide a lighted EXIT sign over the swinging breakaway panel on the new "handicapped" sliding door from the dayroom. An Fminl t1nnnr4 vn;f , C.,,..1.....,. r. Ms. Judy Cline, Adm. Lynwood HCC, Fridley Page 2 October 2, 1992 Please contact this office for an inspection when the work is complete. If you have any questions, please call me at 612-643-2186. Sincerely yours, Rex C. Stromquist, P.E. Public Health Engineer Engineering Services Section RCS/res/mj 1 cc: Al Urspringer, State Fire Marshal's Office Beverly Hartman, Unit Supervisor, Metro C 0 on LA 129 IL: 127 175 (,FM 61, 125 i' f 124 L -L IE I 120 I rY r l (7r.:'.�%�:il �4 !w DAY' O M IZ°xIZpo,1J THrd • i r (� i Gt1KB ¢ FLASNII�JC� 118 Sb p � �9 np lite �^ 1 T 1.. I LINEN II lAtl U ski 5 —� r— SOIL. UTIL. SHO ER 9 z 123 I 111ZI1x1 � Cod w)- 121 R i 175 3 GFM VD eh/ v X I LINEN II lAtl U ski 5 —� r— SOIL. UTIL. SHO ER 9 z 123 I 111ZI1x1 � Cod w)- 121 R i 175 3 GFM VD eh/ v ( a .-tk olt , j7VI L CL 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 C� / JOB ADDRESS 7d S ` i Ve ,� [� 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. ,190 Gas Piping (Needed with new furnace) $ 10.00 $ l / OWNER L-. 0 -P!) L L12 - Gas Range $ 10.00 $ _ / BUILDING USED ASL" l L 11'4 /ilt:5- Gas Dryer $ 10.00 $ / � ESTIMATED COST O U PERMIT NO. l _ *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 Wate (Warm Air) Trade Name pti� -/",- Size No. G - Commercial/Industrial 35 BTU SO _r1r) <9 HP _ EDR 1% of Value of Appliance or Work Fuel �'/t Total Connected Load 0: i State Surcharge $ .50_ Burner Trade Name Size No. BTU HP EDR TOTAL FEE HEATING COMPANY r2 MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 Signed By Tel No. PLUS THE $.50 STATE SURCHARGE 2 REINSPECTION FEE $30.00 Approved By Rough -In Date Final Date *Air Conditioners can not be placed in a side yard without ;146 written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION ON 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 CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1993 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES r;i, • Residential Furnace Shell and Duct Work, Burner — Also Replacement Furnace Gas Piping (Needed with new furnace) Gas Range Gas Dryer *Air Conditioning — All Sizes All Others/Repalrs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1% of Value of Appliance or Work JOB ADDRESS ,59&0 Al E CST JzG dL?ln_ The undersigned hereby makes application for a permit for the work herein Rate TOTAL 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 $ 20.00 $ representations stated in this application are true and correct. % 193 $ 10.00 $ OWNER Lly IU VJ001)$10.00 $ BUILDING USED AS___��-t/�S l�J��rri $ 10.00 $ ESTIMATED COST S ;y PERMIT N0. $ 10.00 $ DESCRIPTION OF FURNACE AND OR BURNER State Surcharge TOTAL FEE $/'!;-00X $ kZ MINIMUM FEE FOR ANY HEATING/COOLING-LVENTILATION REFRIGERATION AIR CONDITIONING PERMIT IS $15.00 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. No, of Heating Units Circle One (Steam) (Hot Water) Trade Name _ Size No. BTU HP EDR Fuel Total Connected Load Burner Trade Name Size No. BTU HP EDR (Warm Air) HEATING COMPANY Signed By Tel No. Approved - Rough—In Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE g 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 ( ) 5. Has total heating BTU's of All other BTU's TOTAL BTU's Remarks List Alterations Being Done: HEATING COMPANY Signed By Date 1 �— CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE 11b, ` Fridley, MN 55432 ) 0 572-3604 Stories Basement Floor 1 Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: irate APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Bath ? Wash Drtnk Floor Catc Auto. Urinal Tub Shower SEnk Tray Fount Drain Basin Washer NO. RATE TOTAL New Fixtures $ 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 $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance, c9 -c/. -7 State Surcharge $ .50 TOTAL FEE $3©. at�)- JOB ADDRESS 6:7EC- /�-�Z7 L��� rbc ��@ !J F-AS,'T 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. '1996 Owner L S�)61000-0L'i f� f6-/' _ Building Used As CAvo Estimated Cost A ek!S, PERMIT NO. PLUMBING COMPANY y(7��L-c.�►-.u� SNC SIGNED BY GLL TEL Approved By Rough—In Date Final Date MINIMUM FEE FOR ANY PLUMBING/ AS PERMIT IS $20.0 PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES. CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE �, (� 0 0 i 4 RS Fridley, MN 55432 �1 1APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 572-3604 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On January 1, 1999 X Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE $ .50 SIGNED BY Approved By /-V--f Rough—In Date PLUS THE $.50 ATATE SURCHARGE TEL N0. "/ 3`1 �'% /0 1 Final Date PERMIT IS $20.00 **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES. )�') V -/ /--) fi 9 S0V � PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS a / New Fixtures 11G6 $ 7.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $ 7.00 and representations stated in this application are true and correct. Catch Basin $ 7.00 ✓ � Rain Water Leader $ 7.00 6/ ,, '1999 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Owner Water Heater —Electric $ 7.00 p > Water Heater — Gas** $10.00 Building Used As Gas Range** Gas Dryer** $10.00 $10.00 Estimated Cost PERMIT NO. Back Flow Preventer Required ( )Yes () No Type $15.00 N PLUMBING COMPANY, Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE $ .50 SIGNED BY Approved By /-V--f Rough—In Date PLUS THE $.50 ATATE SURCHARGE TEL N0. "/ 3`1 �'% /0 1 Final Date PERMIT IS $20.00 **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES. CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On May 10, 1999 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** Gas Range** Gas Dryer** _ Back Flow Preventer Required ( )Yes () No Type RATE TOTAL JOB ADDRESS $ 7.00 The undersigned hereby makes application for a permit for the work herein $ 4.00 specified agreeing to do all work in strict accordance with the city codes $ 5.00 and rulings of the Building Division, and hereby declares that all the facts $ 7.00 and representations stated in this application are true and correct. $ 7.00 br_7 $ 7.00 '1999 $ 7.00 $10.00 Owner � YC-,/ n� $ 7.00 $10.00 Building Used As $10.00 $10.00 -- Estimated Cost PERMIT NO. $15.00 PLUMB1 G CO-M-PMY Reinspection Fee $47.00/Hr SIGNED BY TEL NO.�����Z Z�7� ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance / Approved By Rough -In Date Final Date � /( State Surcharge $ .50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00 TOTAL FEE $ •�b PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES. CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTAI I Fn nw FArrO Fir nnR Effective On January 1, 1999 REPLACECOMMERCIAL DISHWA PLUMBING FUCTURERATES: NO. RATE TOTAL JOB ADDRESS 5700 N.E. RIVER ROAD New Fixtures $ 7.00 �E 1"'' Wash bnnl� Floor GfGE = Auto. G` Gas likie= Water Heater r Stories Urinal '€FIs Shower 5irk= Tray Fattnt Drain #a In ' Washer tiz pl ,.: Range :FixC ..,.:Gas Elec ase a Basement $10.00 Gas Range" $10.00 Gas Dryer** $10.00 Back Flow Preventer Required ( )Yes O No Type_ _ $15.00 Floor 1 - ' _ Floor2 A5, - Floor ----- - - a - Floor 4 s _ PLUMBING FUCTURERATES: NO. RATE TOTAL JOB ADDRESS 5700 N.E. RIVER ROAD New Fixtures $ 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 Heeter — Electric $ 7.00 Water Heater — Gas** $10.00 Gas Range" $10.00 Gas Dryer** $10.00 Back Flow Preventer Required ( )Yes O No Type_ _ $15.00 Reinspection Fee $42.00/W ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5,% of Value of Fixture or Appliance 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 fads and representations stated in this application are true and correct, Owner LYNWOOD HEALTH CARE CENTER Building Used As NURSING HOME Estimated Cost 1..600.00 PERMIT N Ic! PLUMBING COMPANYBOEDEKER PLUMBING & HEATING SIGNED BY ' TEL N0. 827-43ll C. BOPEKER Approved By/ Rough—In Date Final Date State Surcharge $ so MINIMUM FEE R ANY PLUMBINGJGAS PERMIT IS $200D TOTAL FEE $.5� PLUS THE $.50 STATE SURCHARGE �/ISS "COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A- MINIMUM SIZE 9 SQ INCHES. G b 3 Ura` q,r) SuBjECT PERM City of Fridley 32478 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIP rr • _ COMMUNITY DEVELOPMENT DIV. f PROTECTIVE INSPECTION SEC / NUMBEA REV DATE -T PAGE OF APPROVED By CITY HALL FRIDLEY 55432 612-571-3450 910-F15 3/26/02 JOB ADDRESS 5700 East River Road NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt 1S Auditor's Subdivision #78 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lynwood Manor Nursing Home 5700 East River Road NE 1-800-666-9996 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Interstate Roofing & WTP Inc. N5544 Commerce Rd, Onalaska, WI 54650 1-608-783-2106 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Commercial 7 CLASS OF WORK ❑ NEW ❑ ADDITION O ALTERATION j7 REPAIR O MOVE ❑ REMOVE B DESCRIBE WORK Ballasted Reroof Building - Install 60 mil Firestone Rubber Roofing 9 CHANGE OF USE FROM TO STIPULATIONS Need roof and insulation specifications. Insulation shall meet Minnesota Energy Code. Roof per Chapter 15, 1997 UBC - roof slope and drainage. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING, HEATING, TYPE OF CONST OCCUPANCY GROUP OCCUPANCYLOAD 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 I 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 @ $73,512 $36.75 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. $811.75 Fire SC $73.51 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK F TOTAL FEE / � 922.01 SIGNATURE OF CONCRACTOR OR AUTHORIZED AGENT iDATE. EN ROP VALID T THIS IS PERMIT _ Bt -NSP ;yc FiAiE S,GNATUREOF 0WNERIIF0WNERBU4DERi iDATE- r1AR-2a-2002 NEW [ ADDN (j ALTER (xj 09:41 INTERSTATE ROOF & bJTP., 1608 7e3 19aa P.02i07 CITY OF F-RIULtT cr[ecnve a ucuvt 6431 University Ave NE, Fridley, MN 55432 (763) 5723604 Bldg Insp SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address 5700 East River Road LegalOescription: Lynnwood Healthcare Center Owner Name & Address: Beverly Enterprises - Minnesota, Inc. Tel,# (800)666-9996 Contractor, Interstate Roofing & WTP, Inc. MN LICENSE# Address: N5544 Conunerce Road, Onalaska, WI 54650 Tel. # (608)783-2106 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT -11 LMNG AREA: GARAGE AREA: DECK AREA: OTHER: Roof Length Width Height 'Sq. Ft Length Width Height Sq. Ft Length Width Hgt/Ground Sq. Ft Length 180' Width 43' Roof Height 16'_ Sq Ft 17,172 sq ft Construction Type: R r of Estimated Cost $ 73-912-00 Driveway Curb Cut Wdth Needed: Ft + 6 Ft = Ft x $ =S -K�DATE: 2L 0 Z- APPLICANT: ` Tel. # (608) 783-2106 Call (763) 572.3604 for Permit Fees if mailing in application or Fax to 763.671-1287 if using credit card and we will call you for card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL CITY USE ONLY - $�S' $ $ �-3 G • ?$ s%? , o r 3sda. 1's70/ � •vim ��� �..li'���-�` Fee Schedule on Reverse Side .001 of Permit Valuation (1110th%) $.50/$1,000 Valuation $1200 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. " 6" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] STI PU LATIONS= �. �eao- -eZ, MAR -20-2002 09:41 INTERSTATE ROOF & I,,ITP. , 1608 783 1900 P.03/07 . FBPCO No. O . . . . . . . . . . . . .®. ®. . . . . . . . . . . . . . . . Y-•�• -� . . . . . . . . . 01 . . . . . . . . . . .d . . . . . . . . . . . . . . . . . . . . . . r rpm--T—•--� I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Drawing does not need to be to scale but must include dimensions. Roof Drawing Form (ARD) =05 M=- 1= NOTE: -r-,�t� ` • An Accurate Rml' Drawingmuss be suhmined with the PIN (Pm-Installmion Notice) or RFI 7Appicator. 1 der%L oie 11A. r, Lic. NO.' (Request For Inspnction) swing all penetrations before an iacpertion can he completed. • All dctails must he in conVortnuce with cunent Firestone specifications, Of an approved deviation. dingID: f �C' r • Ar: a supplier of marerti rl only, Frtstunc Building Produm assumes no mponsibility for cntaa in deign engineering, quantities, or dimensions, Roof Accessibility No Ladder Needed C1 Ladder at job site • If this dnwins form is too . maximum I mall for the project. a roof drawing may be submitted on p� I x I T' graph paper. 4copics will be needed. � Foot Ladder Needed Ladder Length Firestone Building ro uc on ra Y ovilrMo4gt Whp.otoarmel, IN 46032 MAR -20-2002 09:41 INTERSTATE ROOF & WTP., 1606 783 1900 R.01/07 To: �� t fYi�(euC�fita'IS From: hs 07-, Fax: (�' 3� Gi .� Pages Phone a®:B k,j tPernl't NOTES/COMMENTS: Date: 3 2Z L C�.�1G( �C'�►'lfiaC�r �-i C� c��e, ��li C��G�'1 S al Iun 8/9/02 Executive Director/Maintenance Director Lynnwood Healthcare Center 5700 East River Road Fridley, MN 55432 Reference: Roof Warranty To Whom It May Concern: Enclosed is the warranty for your new roof. This warranty should be kept in an accessible location. The contractor holds a leak free warranty for the first five years of your new roof, after that the Manufacturer picks up the warranty for another 10 years. If, for any reason, the contractor is unable to respond for the first 5 years, or if he goes out of business or sell his company, the manufacturer will respond. You will need the warranty number when contacting the manufacturer. Please read the warranty carefully to understand what is and isn't covered, and if you have any questions, please call me. Sincerely, E.J. Sandquist Memco, Inc. 1795 Third St. 11 Napa Valley, CA 11 94559 Tel: (707) 258-0760 11 USA: (800)788-0360 11 Fax: 7071258-0761 :�¢s roDO7 � ROOFING SYSTEM( LIMITED WARRANTY Warranty #RD033964 FBPCO # EA1109 Square Footage 17,172 s.f. Building Owner BEVERLY ENTERPRISES -MINNESOTA INC. Building Identification LYNNWOOD HEALTHCARE CENTER Address of Building 5700 EAST RIVER ROAD FRIDLEY MN 55432 Warranty Period FIFTEEN (15) Years Beginning on 06/06/02 Roofing Contractor INTERSTATE ROOFING & WTPFG. (0119G ) For the warranty period indicated above, Firestone Building Products limited liability company, warrants to the Building Owner ("Owner" Definitions set forth below, repair any leak in the Firestone Roofing S TERMS, CONDITIONS, 1. The System is limited to mean the Firestone brand membranes, I in aceXifq ice withfkistohe technical specifications. 2. In the:epenY any.leStcSff6bld occur in the System; (a) The Owner r leak ,;y `so notifylf)g Firestone, the Owner authorizes Firestpng Firestone determined that the leak is not excluded under the Irl Owner's sole andeXc(u'i/e;remedv and Firestone`s liability wd,6.01 to pay for these costs shall render this Red Shield Roof System of the type and/or extent of repairs required to be made at the C pired portion of its term -.Failure by the Owner to properly make in a reasonable time shiftiender this LimitedWarranty null an( cerning this Limited tlVarfatlfjr shail.be settled; by mediation. I claim in mediation the 'O'fi r anti Firestone agree that neithel courts of Hamilton 67Qu.t)i in ttte state of'Indiana or the Uniteif' irrevocably consents fo ttlr'jurisdiction and venue of the above ompany ("Firestone"), a division of SFS Diversified Products, LLC, a Delaware Opve that Fur<stone will, subject to the Terms, Conditions, Limitations, and (,System=� tE c., t�D kFINITIONS Atone brand insulation, and other Firestone brand accessories when installed $t>give written notice to.Firestone within thirty (30) days of any occurrence of a Its'd sl9Ree to investiga;ie the. u�fe,�f the leak. _(b))f upon jnvg¢tigation, gitditlbilS, Limitationa,ant'�Itidrts set forth in this limited,wartanty the to lira repair of the leak (d)I�o uld ttie investigation reveal -titat th9 leak is t�trtY�rsis fesponsible for payl�9nt'ttf the htyeetrgaUon costs Fatlfl'>'et� t�;ier urs in a reasonable mantler ,an'eetone IicensedNoatoCCtd 6Yith Any dispute, controver&y ¢V 4 M #fg�+Keen the"OVViier anEX Fi�b5t6ite Con - that the Owner and Fire f�.xto 4 �Osolve,the dispute, controversy or commence or prosecuf%41*�tt1 prooeedihi ; or claim other than in the trict,Court, Southern D4#0 6fJhdiana, Indianapolis Division. Each party 3. Firestone shall have n0.Qbligation under this Limited Warranyunte55Fan Until Firestone and;thA<Na$ ed applicator have been paid in full for all materials, supplies servrges, warranty costs and other costs which e9nCluded m ,WJneldbntat q, tits System , 4. Firestone shall have no olilfgation under this Limited Warranty, or arty oftterliabiiity, note oC in'thg'Leak or,.damage,is caused by: (a) Natural forces, disasters, or acts`of God including, but not limited to, windsirtdxcess of 55 MPH, hurrioan,rtofdadoes,lisil lighte tg„EaTtl9ilua "atom- is radiation; insects or sritinals; (b) Any act(s), conductor omission by any person, or act(s) oiyl/aY, rna )es the Systf)M d{vVt►idh it fp irs the System's ability to resfst;feaks; (c) Failure by the Owner to userroWhible care in maintaining l3$ S)rsie f id;maintenari Ad o rtc►00 qut,not limited to those items listed on the MLrse side of this Limited Warranty titled "Firestone RoofingC tf�1 Maintenance" (d) Det *Mitfon or M1ure of building components, including, but not limited to, the roof substrate, walls, mortar, HVAC un6lko2w ="(e) Condensation or;infititatl#ii of m4i4ure in, through, or around the walls,copings, rooftop hardware or equipment, building structure or undelly.ftgr'surrounding materials JJJ;estoner S ecif- ically excludes any damage to the Firestone insulation or roof system that may come from moisture Sy(thi[f ttte'.roof deck or exisUng.r6f system. (f) Any acid, oil, harmful chemical, chemical or physical reaction and the like which comes in contaot`1yl h the System, which damages-ths System, or which impairs the System's ability to resist leaks; (g) Alterations or repairs to the System not a*toed in writing by Firestone; (h) The ar4ftite!3Ure, engineering, construction or_design of the roof, roofing system, or building. Firestone does hof'Utdertake any analysis of the architecture 0rong(- neering required to evsI04te what type of roof system is appropriate; (i) A change in building use or purpose; 0) Failure to give proper notice as set forth in; paragraph 2(a),above. 5, This Limited Warranty sftali be transferable subject to Firestone inspection, written approval, and payment of the current transfer fee. 6. During the term of this Limited Warranty, Firestone, its designated representative or employees shall have free access to the roof during regular busi- ness hours. In the event that roof access is limited due to security or other restrictions, Owner shall reimburse Firestone for all reasonable costs incurred during inspection and/or repair of the System which are due to delays associated with said restrictions. Owner shall be responsible for the removal and replacement of any overburdens, superstrata or overlays, either permanent or temporary, excluding accepted stone ballast or pavers; as necessary to expose the system for inspection and/or repair. 7. Firestone's failure to enforce any of the terms or conditions stated herein shall not be construed as a waiver of such provision or of any other terms and conditions of this Limited Warranty. 8. This Limited Warranty shall be governed and construed in accordance with the laws of the State of Indiana without regard to conflict of laws. FIRESTONE DOES NOT WARRANT PRODUCTS INCORPORATED OR UTILIZED IN THIS INSTALLATION WHICH IT HAS NOT FURNISHED. FIRE- STONE SPECIFICALLY DISCLAIMS LIABILITY, UNDER ANY THEORY :OFLAW, ARISING OUT OF THE, INS,TALLATION OR P�fAFORMANCE OF; OR DAMAGES SUSTAINED BY OR CAUSED BY, PRODUCTS NOT FURNISHED BY FIRESTONE. THIS",C IMITED WARRANTY,SUPERSEDES AND IS IN LIEU OF ALL OTHER WARRANTIES OR GUARANTEES WHETHER WRITTEN OR ORAL, EXPF SS OR IMPLIED; 7Nt.'! UDING, WITHOUT LIMITATION, WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE ,;THIS LIMITED WARRANTYSHALLBE THE OWNER'S SOLE AND EXCLUSIVE REMEDY AGAINST FIRESTONE, AND FIRESTONE SHALL NOISE -TABLE FOR ANY CON$r-QUENTIAL, SPE- CIAL, INCIDENTAL OR OTHER DAMAGES INCLUDING, BUT NOT LIMITED TO, LOSS OF PROFITS Qa DAMAGE TO THE BUILDING OR ITS CON- TENTS OR THE ROOF DECK. THIS LIMITED WARRANTY CANNOT BE AMENDED, ALTERED OR -MODIFIED IN ANY WAY EXCEPT IN WRITING SIGNED BY AN AUTHORIZED OFFICER OF FIRESTONE. NO OTHER PERSON HAS ANY AUTHORITY TO BIND FIRESTONE WITH ANY REP- RESENTATION OR WARRANTY WHETHER ORAL OR WRITTEN. BY: Georc AUTHORIZED SIGNATURE: TITLE: Me Furman FIRESTONE ROOFING CARE AND MAINTENANCE (For Red Shield Warranted Roofing Systems) Congratulations on your purchase of a Firestone Roofing System! Your roof is a valuable asset and as such should be properly maintained. All roofs and roofing systems require periodic maintenance to perform as designed and to keep your Limited Warranty in full force and effect. 1. The roof should be inspected at least twice yearly (in the Spring and Fall), and after any severe storms. Record maintenance procedures as they occur. Log all access times and parties working on the roof. 2. Proper maintenance and good roofing practice require that ponded water (defined as standing water on the roof forty-eight (48) hours after it stops raining) not be allowed on the roof. Roofs should have slope to drain and all drain areas must remain clean. Bag and remove all debris from the roof since such debris can be quickly swept into drains by rain. This will allow for proper water run-off and avoid overloading the roof with ponded water. 3. The Firestone Roofing System should not be exposed to acids, solvents, greases, oil, fats, chemicals and the like. If the Firestone Roofing System is subject to contact with any such materials, contact Firestone immediately. 4. The Firestone Roofing System is designed to be a waterproofing membrane. If there is to be roof traffic for any reason, contact your Firestone Licensed Applicator before proceeding for the installation of approved protective walkways. 5. Some Firestone roofing membranes require maintenance of the surface of the membrane in order to perform as designed: a. a. The application of an approved liquid coating, such as Aluminum Roof Coating to smooth surfaced APP membranes provides additional protection from the environment. If this coating is not applied as part of the initial roofing installation, it should be applied within the first five years after the roof is installed to help protect the membrane from surface cracking inherent in such asphalt products. In addition, this coating should be maintained as needed to recover any areas of the coating that have blistered, peeled or worn through. b. Granular surfaced APP and SBS membranes do not normally require surface maintenance other than periodic inspection for contaminants ( See Item 3. ), cuts or punctures. If areas of granular loss are dis- covered during inspection, new granules should be broadcast into hot asphalt or emulsion to protect the surface of the membrane. c. Gravel surfaced BUR membranes do not normally require surface maintenance other than periodic inspection for contaminants ( See Item 3 ) or damage. If areas of gravel loss are discovered during inspection, gravel must be reinstalled into hot asphalt to protect the surface of the membrane. Smooth surface BUR membranes must be kept coated using original coating materials for the life of this warranty. d. EPDM and other single -ply roofing membranes do not normally require surface maintenance other than periodic inspection for contaminants ( See Item 3. ), cuts or punctures. Occasionally, approved liquid roof coatings, such as Firestone AcryliTop, are applied to the surface of EPDM membranes in order to provide a lighter surface color. Such coatings do not need to be maintained to assure the performance of the underlying EPDM roof membrane, but some maintenance and re -coating may be necessary in order to maintain a uniform surface appearance. 6. All counterflashing, metal work, drains, skylights, equipment curb and supports, and any other rooftop accessories functioning in conjunction with the Firestone Roofing System must be properly maintained at all times. 7. If any additional equipment is to be installed on your roof (e.g. HVAC units, TV antennas, etc.), contact Firestone, in writing, for approval before proceeding. 8. Should there be an addition to the building, requiring tie-in to the existing Firestone Roofing System, contact Firestone before proceeding to ensure the tie-in is in accordance with Firestone specifications. 9. Should you have a problem: (a) Check for the obvious: clogged roof drains, loose counterflashings, broken skylights, open grills or vents, broken water pipes. (b) Note conditions resulting in leakage. Heavy or light rain, wind direction, temperature and time of day that the leak occurs are all-important clues to tracing roof leaks. Note whether the leak stops shortly after each rain or continues to drip until the roof is dry. If you are prepared with the facts, the diagnosis and repair of the leak can proceed more rapidly. (c) Contact Firestone Warranty Claims at 1-800-830-5612 immediately... but please don't call until you are reasonably sure that the Firestone Roofing System is the cause of the leak. Firestone feels that the preceding requirements will assist you, the building owner, in maintaining a watertight roof for many years. Remember, your roof is an investment. To maximize your return on this investment, maintenance is essential. 'Firestone BUILDING PRODUCTS NOBODY COVERS YOU BETTER.® 525 Congressional Blvd. Carmel, IN 46032-5607 1-800-428-4442 • 1-317-575-7000 • Fax 1-317-575-7100 4/02 — Item #811 R (Replaces 2/o0) -o1 www.firestonebpco.com 2 41f t � Fi3r NOW a Congratulations on your purchase of a Firestone' ing Ffa6ri AT, such sh ould be properly maintained. All roofsrectfire and to*ke`ep your Limited Warranty in full,force i � .; # rl�d Maintenance" printed on'ttie back bf your,Ftreston z >• important items to" assist you in maintaining a�watertI guidelines -recommend that the roof be Ins pec ed at lea be perfomlec3 by any.qualified person selected by`you, F inspection every year be conducted by the Firestone Li one . , 713 t� , -• �i `f Emv;'� , em! Your new roof is a valuable asset and as �3�' � Roofing re n :ed Warr4�q.jyT6 aih E number of I ma t roor:to.r many twice:yeady. Aitnougn anis inspecuon can . estone recommends that at least one ensed Applicator who installed your roof. Whenever an inspection of the roof is performed, Firestone recommends that the following items be included: M ROOF CONDITIONS REQUIRING PERIODIC INSPECTION: Periodic inspection of the following items is very important to assure that the Firestone Roofing System not been exposed to conditions not covered by Firestone's Limited Warranty: a. Roof Traffic & Walkways: As stated in Firestone's System Design Instructions for all Firestone Roofing Systems, "Walkways help protect the membrane from damage due to necessary roof- top service traffic." Please note that walkways should be maintained at all roof access points, around all mechanical equipment which requires maintenance and at all areas where roof traffic more frequent than once a month is anticipated. If, because of traffic requirements, walkways need to be installed on your roof, contact your Firestone Licensed Applicator before proceeding. d. Discharges: All components of the Firestone roof system must be protected from discharges, such as petroleum products, greases, oils and fats, acids and the like. If the building will have any such discharges, please contact Firestone for suggested methods of protection. If, because of the presence of chemical discharges, protection measures are recommended, contact your Firestone Licensed Applicator before proceeding. s, e 2 41f t � Fi3r NOW a Congratulations on your purchase of a Firestone' ing Ffa6ri AT, such sh ould be properly maintained. All roofsrectfire and to*ke`ep your Limited Warranty in full,force i � .; # rl�d Maintenance" printed on'ttie back bf your,Ftreston z >• important items to" assist you in maintaining a�watertI guidelines -recommend that the roof be Ins pec ed at lea be perfomlec3 by any.qualified person selected by`you, F inspection every year be conducted by the Firestone Li one . , 713 t� , -• �i `f Emv;'� , em! Your new roof is a valuable asset and as �3�' � Roofing re n :ed Warr4�q.jyT6 aih E number of I ma t roor:to.r many twice:yeady. Aitnougn anis inspecuon can . estone recommends that at least one ensed Applicator who installed your roof. Whenever an inspection of the roof is performed, Firestone recommends that the following items be included: M ROOF CONDITIONS REQUIRING PERIODIC INSPECTION: Periodic inspection of the following items is very important to assure that the Firestone Roofing System not been exposed to conditions not covered by Firestone's Limited Warranty: a. Roof Traffic & Walkways: As stated in Firestone's System Design Instructions for all Firestone Roofing Systems, "Walkways help protect the membrane from damage due to necessary roof- top service traffic." Please note that walkways should be maintained at all roof access points, around all mechanical equipment which requires maintenance and at all areas where roof traffic more frequent than once a month is anticipated. If, because of traffic requirements, walkways need to be installed on your roof, contact your Firestone Licensed Applicator before proceeding. d. Discharges: All components of the Firestone roof system must be protected from discharges, such as petroleum products, greases, oils and fats, acids and the like. If the building will have any such discharges, please contact Firestone for suggested methods of protection. If, because of the presence of chemical discharges, protection measures are recommended, contact your Firestone Licensed Applicator before proceeding. c. Ponding Water: Proper maintenance and good roofing practice suggests that ponded water (defined as standing water on the roof forty-eight (48) hours after it stops raining) should not be allowed on the roof. Roofs must have slope to drain and all drain areas must remain clean. If ponded water areas are observed on the roof that cannot be corrected by periodic cleaning of drain areas, contact your Firestone Licensed Applicator. d. Storms: The roof should be inspected after any severe storm, especially after any storm that involves high sustained winds, heavy wind gusts or tornado-like conditions. All roof surfaces should be inspected for damage caused by wind-blown debris. The roof also should be inspected after any hail or ice storm which could damage the roofing system. If storm -re- lated damage to the roof system is observed, contact your Firestone Licensed Applicator before proceeding. e. Moisture Infiltration: It is very important to inspect the roofing system for moisture infiltration from sources excluded by Firestone's Limited Warranty. These sources can include but are not limited to: 1. Latent moisture in a pre-existing roofing system or roof insulation remaining beneath the Firestone Roofing System. 2. Moisture infiltration in or through building walls, copings, mortar joints and roof -top equipment. 3. Condensation of water vapor within the roofing system due to temperature and humidity differentials. Because inspection for moisture infiltration requires professional roofing experience, Firestone strongly recommends that this inspection be performed by a Firestone Licensed Applicator at least once a.year. NON -FIRESTONE MATERIALS: In some instances, non -Firestone supplied materials are used in conjunction with Firestone Roofing Systems. These materials may include, but are not limited to the following items: a. Locally -fabricated sheet metal flashings. b. Non -Firestone sealants at roof terminations. c. Non -Firestone roof insulations. d. Non -Firestone insulation fastening devices, including but not limited to roofing screws, insulation plates, construction adhesives and roofing asphalt. e. Preservative -treated wood nailers and blocking. f. Roof drains and drain inserts. g. Pre -fabricated roof curbs. h. Concrete walkway or ballast pavers. i. Stone ballast. j. Roof coatings. lFirestone 1.; Y' b� Because such items are not warranted by Firestone, it is important for you to establish an ongoing inspection and maintenance program to assure that the performance of non -Firestone materials does not adversely affect the weathertight integrity of the Firestone roofing system. Sheet metal items should be checked for weathertightness and re-anchored/recaulked as needed. Nailers and blocking should be checked for soundness, and replaced or re -secured if necessary. Roof drains and drain inserts should be cleared of any debris. Sealants should be inspected for shrinking or cracking and replaced as required. The integrity of roof insulation and insulation attachments should be verified. Walkway pavers should be checked for cracking or splitting and replaced if necessary. Ballast stone should be checked for deterioration due to freeze/thaw conditions. In addition, all ballasted roofs should be inspected for localized wind displacement of the ballast, especially along perimeter roof areas. In the event ballast displacement is observed, the ballast should be re -dispersed uniformly and the addition of larger ballast stones should be considered. ROOFING PRODUCTS REQUIRING PERIODIC MAINTENANCE: Some Firestone roof coatings and sealants require periodic maintenance to assure long-term per- formance and to keep the Firestone Limited Warranty in full force and effect. These products include but are not limited to the following items: a. Roof Coatings. b. Sealants. Because such items must be maintained to keep the Firestone Limited Warranty in full force and effect, it is important for you to establish an ongoing inspection and maintenance program to assure that the performance of these products does not adversely affect the weathertight integrity of the Firestone roofing system. Roof coatings should be checked for checking, peeling or cracking and recoated as necessary. Sealants should be inspected for shrinkage or cracking and replaced as required. Mainte- nance to Firestone products must be performed by a Firestone Licensed Applicator. FIRESTONE PRODUCTS REQUIRING PERIODIC INSPECTION: Although the following Firestone products do not necessarily require periodic maintenance to assure long-term performance, periodic inspection is very important to assure that these products have not been exposed to conditions excluded by Firestone's Limited Warranty: The Firestone Roofing Membrane should be inspected for tears or punctures caused by wind storms, falling objects, roof traffic and the like If the Firestone membrane is supplied with a factory applied coating, such as roofing granules, the coating should be inspected for any discontinuities caused by abrasion from wind, roof traffic or other sources. Tears, punctures and abrasions to the membrane must be repaired by a Licensed Firestone Applicator using Firestone specified repair procedures. In addition, the membrane should be inspected for any contamination from discharges, such as petroleum products, greases, oils and fats, acids and the like. If any such.discharges are observed on the membrane, please contact Firestone for suggested methods of protection. If, because of the presence of chemical discharges, protection measures are recommended by Firestone, contact your Firestone Licensed Applicator before proceeding. b. Firestone Wall Flashings also should be inspected for tears, punctures, abrasion and contami- nation from discharges, following the same procedures as for the Firestone Roof Membrane. ROOF INSPECTIONS AND SAFETY: Inspection of any roof should be undertaken only by qualified persons who are familiar with safe, roofing practice, including all applicable occupational health and safety regulations relating to roofing and construction. Firestone recommends that all roof inspections be performed by a Firestone Licensed Applicator or a similar roofing professional. 13 ARRANGING FOR PERIODIC ROOF INSPECTIONS: Please note that the cost of periodic inspections of your roof, either by your Firestone Licensed Appli- cator or by any other roofing professional, are not included in the cost of your Limited Warranty. Firestone recommends that you contact your Firestone Licensed Applicator to obtain a proposal for inspection and maintenance services. Firestone feels that the preceding guidelines will help you maintain a watertight roof for many years. Whenever you have questions concerning your roofing system, do not hesitate to contact your Firestone Licensed Applicator or your local Firestone Sales Representative. IF'rest01111111111,9C BUILDING PRODUCTS NOBODY COVERS YOU BETTER.0 525 Congressional Boulevard • Carmel, IN 46032-5607 1-800-428-4442 1-317-575-7000 Fax: 1-317-575-7100 03(02 — ftem #828 (Replaces 01101) m ed O ,� o' y�YY G o G G T 14 11, is ip o'N O .♦ J .p 'GJ w Jp T �SkA J�G ` G 9Gtp ya'6 i ION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604 Effective Un Jan 1, 2UU2 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 9-1 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE New Fixtures $ 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 TOTAL JOBADDRESS 57,0 6e, i �V�✓� �c�c��Q 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. 20 Owner L�i✓(1j woOU Cc- Ir Building Used As G` (-r` v jz- do�� Estimated Cost 2�qoo � PERMIT NO. PLUMBING COMPANY ' V 0f -VV CkV J A -Q- C.6M %cct 1 �J�tTv�C'i�f�,�al1�� Reinspection Fee $47.00/Hr SIGNED BY A,� 1- ;2;�� TEL N0. %6 3 -S'YY- 5100 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS ®c>O FAX# 763' Y `S 7G 1.5% of Value of Fixture or Appliance Approved By Rough -In Date Final Date State Surcharge .50 MINIMUM FEE F R ANY PLUMBING/GAS PERMIT IS $20.00 TOTAL FEE $ % ASO 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 THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED COMMON VFNT, VFNT ONN CTOR ANn COMMISTION AIR VFRIFICATInN 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 (i No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes (I 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 -LAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes( ) No( ) The Pxis ing comNintion air is sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When required to install a new rambustinn air; it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When insta11inn a n _w v _nting cyctam, 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_ Appliance #2 Type _ Appliance #3 Type Total Appliances Common Vent Type _ BTU Input _ BTU Input BTU Input Total Btu Input Fan Assisted or Nat Fan Assisted or Nat Fan Assisted or Nat 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- crrihPl �v��t 1� Q �5 rQ.� �t �� :r\ +L X N -� HEATING CO: Nap 'ti t'A �NI��I��VI�c�tl CGVI a '� j ��►�C , , Signed By: '� - T Date : —7-3 V `c� Z SUBJECT City of Fridley 32995 AT THE TOP OF THE TWINS BUILDING P E R M I T I T NO. • COMMUNITY DEVELOPMENT DIV. _ r � PROTECTIVE INSPECTION SEC. 4(6 7T I I , NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 763-571-3450 910 F15 8/19/02 JOB ADDRESS 5700 East River Road NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt 18 Auditor's Subdivision #78 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lynwood Manor Nursing Home 5700 East River Road NE 763-571-3150 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Four Season Construction Co PO Box 32033, Fridley, MN 55432 763-786-4039 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Nursing Home 7 CLASS OF WORK O NEW O ADDITION O ALTERATION 6�7 REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Replace metal siding above existing windows and doors 9 CHANGEOFUSEFROM TO STIPULATIONS Per Section 1402, 1997 Uniform Building Code, requires that a weather resistive barrier be placed over exterior sheathing to protect the interior wall covering. Exceptions for this provision would be if sheathing is an approved weatherproof panel or when the siding is an approved weather barrier. Vinyl siding is not a weatherproof covering unless the manufacturer states this in their application guidelines. Call for inspection of wrap before covering. Caulk and flash all exterior openings. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST OCCUPANCY GROUP OCCUPANCYLOAD 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 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES G N G THIS TYPE OF WORK WILL BE COMPLIED $4'500 @2 2r) WITH WHETHER SP IFIED M EIN OR NOT THE GRANTING OF A PERMIT 44 DOES NOT P U E TO AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISION OF NY HER TATE OR LOCAL LAW REGULATING CON- $111.25 SC $4.50 STRUCTI OR E OR NCE ONSTRUCTION /Fire PLAN CHECK FEE TOTAL FEE $118.00 SIGNATURE OFC AGENT tDATE� W N&ERLY VAL TED THIS IS YOUR PERMIT 7T.OPiZED _ K.�' Lp�, , P ,{ - +U ( "ITE S-GNATURE OF Ow NER,I, OWNED BUILDER, IOATEi CITY OF FRIDLEY Effective 1/1/2002 6431 University Ave NE R-3, COMMERCIAL & INDUSTRIAL Fridley, MN 55432 BUILDING PERMIT APPLICATION] f (763) 572-3604 mob, CONSTRUCTION ADDRESS 520'6 0/4-_:4 KI &J2- 12�- Zoning Legal Owner & Addres CONT Tel# Te 1 # Architect Reg.# Engineer Reg.# BUILDING CONSTRUCTION TYPE OF WORK [] New [] Addition [] Alteration -Describe, ae j J!- 1k19' OFC. AREA: Length Width Height Sq. Ft. WHSE AREA: Length Width Height Sq. Ft. OTHER AREA: Length Width Height Sq. Ft. APPLICANT, t,QA2� (� r� Tel 2 :6?�ate 2`101-0 Z -- Sq. Ft. Sq. Ft. Sq. Ft. VALUATION x $ Cost/Sq. Ft. = Valuation x $ Cost/Sq. Ft. = Valuation x $ Cost/Sq. Ft. = Valu--' Uvv� � VVV Building Use Construction Tyn- Air Conditioning []Yes []No Fir Performance Bond Amount $ Permit Fee $ Plan Check $ Fire Surcharge $� U State Surcharge $ 2 SAC Charge $ Erosion Control' $ Park Fee $ Spec. Assessments $ Driveway Escrow $ TOTAL $ A\ It Group []No L 1�1 Received []Yes []No See In Exp .001 x $.50/$1, $1200 per $450.00 Con Fee Determine Agreement Nece fee TOTAL VALUE Reverse Side > $1 Million) determination) Not Necessary [] ,5.50/foot ATTACH STIPULATIONS CIT, OF FRIDLEY INSPECTION DIViSION 64:;.�Sniversity Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 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 Rate TOTAL $ 30.00 $ $ 10.00 $ $ 10.00 $ 10.00 3 $ 25.00 All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.251y, of Value of Appliance or Work 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. JOB Al OWNE Effective On January 1, 2002 BUILDING USED AS / a ESTIMATED COST ci'� �— PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $ Trade Name Size No. _ �i „ BTU HP EDR $ 1 / S v Fuel Total Connected Load Burner Trade Name Size No._ $ BTU HP ED $ 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 YIS-- S'b representations stated in this application are true and correct. $ r DATE © Q kl'--f /1[HEATING CO � �Vice �%r/ y Pi c TEL # FAX # Appdved By Rough In Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE JrHE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED When reIn acing nn 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 -LAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The existing romb s ion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to install a new romhuction 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 #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: Signed By: Date : G7YOF FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287 November 3, 2003 Brooklyn Aire Heating & Cooling 8862 Zealand Ave N STE A Brooklyn Park, MN 55445 Re: Final Heating Inspection at 5700 East River Rd NE, Fridley, MN (Lynwood Manor Nursing Home) Inspection Job Report #145879, 8/21/02 Dear Sirs: In order to obtain final approval for the scope of work allowed under your permit at the above noted address, which would then allow the City to close the permit, the following issues must be addressed: 1) Calculate ventilation per MN Code 7676.1100, Subp 8. 2) Provide balancing report per MN Code 7676.1100 Subp 12. 3) Flash wood sleepers. 4) Replace T -stat wires with UV wire. Please complete the above corrections and call to schedule an inspection if needed with Mary at 763-572-3604. Feel free to contact me at 763-572-3606 with any questions concerning this matter. Sincerely, KEVIN HANSON Mechanical Inspector KH/mh CC: Lynwood Manor Nursing Home uVSt-b—iION DIV. 431 U(iiversity Ave NE . oridley. MN 55432 x163) 572-3604, FAX (763) 571-1287 M C) O O z kD C3 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MART( NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR L:1C vim.. - ... ;-:.. - ..--: �x ''LUMBING Wash s Floor ,-�;:: j�( {�� Auto. - >,-:..;ars has;-: > =Gas $ 7.00 wager neater .;:, r;<;_; t $ 4.00 a ? Shower $ 5.00 Tra _ •, ? =._,. Drain . -- g., Bas_5-� Washer ' < rz Range : ;::: Gas E1e flWA" Stories t Urinal '- 17 , 200 ;ter u)3urnplReceiving Tank a> )*9= Owner4 Nater Healer -Elec: i $ 7.00 p�„�%r>' ,, %?.:i:�r-fJ.•b:y ei�£i ySRO �_ $10.00- ,i„�:Y;_.-•- -. `' %i '"'_i:r LID Range" L : i �ti.�f ' ' ' G► ::i?: '':x::'.-f-::::irs ;i5srf , t $10.00 -atiit._. :%k x�.sK�:!�..-<`:' _ :-�:. •` ;%4 :s."f. 9Lv` }X:i ( ) No $15.00 .,.:. ;5+.'t-: `': ii ri.;.. iL Basement f?i y:t 3' n'.lL `..3'^:Yiii: .9 .�1.-:z\�$t-Y$itA'Y. it Mr( Lc' l! fv[iY ii%4i<i ::„ $f^y i„}�%�3,-?r'- }S$C4.n �4:z '!.r.'"Y ,;• ?:YL<5CL?$E ":.{!-:1.:�1 :L.tr^.:' v.:n v , ^` i:r-�. - nr-i-';: �rf�•:: 2iiiS".. £.:.1�%if"r,�: •. ..-::'<:• Floor 1 ;>f$zx;=:�:Y.,,'_ .c,3`.cr•`.?-9.:Y `f? r::-�: n.r fkYzi:r:::. (r f ( A."i,;<-r, :f.�:y;. !` ,,,+..,(•. if. �i•,•�£':: "i°5?, v� ,-.L' - _ :o-8 <c4 .%�"i-:i4:`.; ;y. �.3n __: :: .... Floor 2 ?.iYi''i y 5'•t: X;if i'vwvf-. [Floor 3 i:�--oj�. _ . 2$� .. ?•'X?W':Si ri .�'t-y�. ..i: �;5.: vvZYtiwa v. :,: i.• �•�� • i'Y Y.Y`.:.S;i.. iT-:�:.:°L�..,: .. - ".'i:::i;.i:'.:: y..r�".i wS:.. (. ?�Yf >Y <>.�z?:: 4.�:<�:r: r.,»� -�;;;, , .. .. t;. ,. �2:Y%Y$• Floor 4.��L.'�L a;$.3. :i•-i�;dJe'S'..-. i.,�iv'�Lti4S_}M .:V£R;:'?z'f :R?. 4I �s��'�i •..- ::S'[� Si. txxz ,'x:?x>A?3r,r;>: ;>�•; xsia'>:krs<Yi IV-> (D ''LUMBING (� (!�&Sf FIXTURE RATES: NO. RATE TOTAL JOBADDRESS 4*-e1CC� 3Z '14ew Fixtures $ 7.00 The undersigned hereby makes application for a permit for the work herein )Id Opening, New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes 3eer Dispenser $ 5.00 and rulings of the Building Division. and hereby declares that all the facts Now Off Basin $ 7.00 and representations stated in this application are true and correct. latch Basin $ 7.00 � Rain, Water Leader. - $ 7.00 '- 17 , 200 ;ter u)3urnplReceiving Tank YT_ $ 7.00 ,' - Nater Treating Apptance$10.00 Owner4 Nater Healer -Elec: i $ 7.00 ` water Heater - Gas" �_ $10.00- Building Used As � Lt,25 tj< div+.P . LID Range" $10.00 ' ' ' G► wGas Dryer" $10.00 Estimated Cost / DDD. Oc0 PERMIT NO. / -Back Flow Preventer Required( )Yes Type ( ) No $15.00 /jn PLUMBING 9,0MPANY ' `� "ti ^� `V / V `Q JkAAJ t CA R. .U^• Reinspection Fee $47.00/Hr SIGNED BY �— :z ALL OTHERS AND/OR REPAIRS AND ALTERATIONS CE: 1.5% of Value of Fixture or Appliance _ U Approved By Rough -In Date _ State Su;;4A 50 ?��j���� MINIMUM FEE OR ANY PLUMBINGI 4M FE -3-L PLUS THEs .50 STATE SURCHARGE TEL No.(7 3; �{- )(�3 S /k1l2 Final Date COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 04(A) A D T COMMON VENT INFO ON BACKSIDE S i'�1/•v LL�Pd � kt- Q�tkse?r ��srls�eo mss -!/.plc. 9?r.�.�.w����- �Sli-/ .2' �•l.c��t5 NORTHLAND MECHANICAL TEL:763-544-9563 Jul 17'03 9:07 No.003 P.02 APPLICATION WILL BE RETURNED When , the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, No and is securely supported and firestopped where required, Yes () ( ) 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 manufacturers specifications. This does include AGA-GAMA Category l Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The is sized and installed to meet the current codes and manufacturer's specifications. Yes (o ( } When required to install a 13pw comhurition a1r.it will be sized and installed Yes () No ( ) to most the current codes and manufacturer's specifications. When ' , 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. Connecinr Yes( )No( ) Informatlnn AP111ianrZy:p and q*zP1CnrnMmn Vant and Vent Appliance #1 Type 016c,c % t&-� A, BTU Input or Nat e Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type 5TU 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 11 �t? � /fie �a "fex— 1 `�eT J� ®LT1=RATjQN-S- (�ha^� MA ode C,j Q e e- f404 1yee4q.1c C4 HEATING CO: - Signed By: Date: , 7-/? —v 3 �. k► .. o/.. .. 4E] Kelly Design Services 763-546-5977 432502 Northland Mechanical Contractors, Inc. 2900 Nevada Avenue North n r Date/. f v 3 Job No. Orsat Test Record New Hope, MN 55427 (763) 544-5100 • Fax (763) 544-5764 Tester's Name O R a Dl License No. 6 FS 22(p Z treet Address city � Zip ode 760 F� Awty ltd ��jIQ SS432 Occupant / Qq ` i ` �Ownel, V r, Lj vi 0041 It1� e Phone (Z�3) 7� Jw Heat Loss —s at Htj. 7:21 Inst. 63 old By S�"^e Installed By N0�-4 k�aiw� Electrical Work By Gas Line By, 15�fh Type of Heat / C1 GA O FA d(HW C1 Steam Q Space Heater 0 Unit Heater C1 Otherj/p f M4er �7t�r Make 0 w �7�5'SAvA)4r � L 10 odel 0vc� 207 `Y 1 Seral No. �ZAi Input OOo Make of Burner Model Max. BTU Rating Make of Furnace Model o ost/fit Heal �ea Plug [� � V EN � Limit a Limit Setting e ?D 6 1 >°� IACcet �7 v ZS fAi t • • Fan Setting Pilot Type Pilot ake sA0, Pilot Model /6nrti-foil Pilot Timing L.W.t Off sq p7114rd SU Vent Size Size Kind of Liner J 8 It 0 None C 7Z S Draft Hood DRA F Regulator 32S-71, 1, Filters Size Number Chimney Location Chimnjy Inside ✓ Outside '� Construction f ! 6 SS B Smoke Bomb Wiring Draft O �, Test Tag Door Pressure Lighting Inst. Pressure 41-5 � WrC � 1'Ka% Percent a 2 1 T Input FH BTUH 1' 7.25 c FH Percent 2 -5,18 tack Temp. .2 a Percent p 12 pp/" p aw G7YOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, November 3, 2003 Northland Mechanical Contractors Inc 2900 Nevada Ave N New Hope, MN 55427 (763)571-1287 Re: Final Plumbing Inspection at 5700 East River Rd NE, Fridley, MN (Lynwood Manor Nursing Home) Inspection Job Report #153058, 7/22/03 Dear Sirs: In order to obtain final approval for the scope of work allowed under your permit at the above noted address, which would then allow the City to close the permit, the following issue must be addressed: Provide combustion air per UMC Chapter 6. Please complete the above correction and call to schedule an inspection if needed with Mary at 763-572-3604. Feel free to contact me at 763-572-3606 with any questions concerning this matter. Sincerely, � e � 4�� - L' Z:). , /� � — VIN HANSON Mechanical Inspector KH/mh CC: Lynwood Manor Nursing Home Northland Mechanical Contractors, Inc. 2900 Nevada Avenue North New Hope, MN 55427 (763) 544-5100 • Fax (763) 544-9563 La u N o rL --C � Cay--�.ri�U�-('10�1 •� i72'yt�P2.5 20 Hof ci N I T I-t1EA7WV1- TO FROM SUBJECTDATE L NLrA z- JOB NO. P. 0. NO. V�5 NT, L,ATi a N 72S��1� II3 o Mr�� t l'S o M 13 �t --- a z.,a Cum, %V 1 Q- t X150 12x0 G�%'► %N �� �'•F'1 s ez SQ e2-,+ )e 157 N r=w 6, A (P- -j-a 6 u' 2A X? 6! V P /aBoVl�s Rvvp� W/ 4" aCI'SL-5 �j 4< Fridley Municipal Center — 6431 University Ave NE, Fridley MN 55432 Building Inspection Department (763) 572-3604 FAX (763) 571-1287 Open Permit Letter March 15, 2005 Northland Mechanical 2900 Nevada Av. N. New Hope, Mn. 55427 Re:Lynnwood Health Care 5700 East River Road Fridley, Mn. 55432 Dear Permit Holder The city building inspection records indicate you have an open permit, correction, and/or inspection that have not been addressed in accordance with Minnesota Rules, Chapter 1300. Within (14) working days after the receipt of this letter, you must contact the Building Inspection Division of the City of Fridley to schedule an inspection. Should you not schedule an inspection within that time period, your permit will be considered expired per Minnesota Rule, Chapter 1300, and all non-compliance issues for which you will remain liable, will be put in the property address file for permanent record at the City Hall. In order to obtain a final approval for the work allowed under your permit at the above address, which would then allow the city to issue a certificate of occupancy, the following issues must be addressed: 1.No final inspection was called in. Please call the number below to schedule an inspection. Please complete the above corrections and call to schedule an inspection with the permit technician at (763) 572-3604. Sincerely, Kevin Hanson Mechanical Inspector CITY OF FRIDLEY BUILDING INSPECTION 5431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer *Air Conditioning - All Sizes All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater -1 � e-� 9a o o4 t, Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS S7 G7 ��2 51– 4 0 ( 9 k"– Fee Total Owner -,rJ ctL it�— T' $35.00 $ Building Used As /v_ Lk E_ � o < Hov"'e— $10.00 $ ESTIMATED COST /66 o•co PERMIT NO &04 -N $10.00 $ DESCRIPTION OF FURNACE AND BURNER $10.00 $ # of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. $25.00 $ BTU HP EDR Fuel Total Connected Load $ Burner Trade Name Size No. BTU HP EDR Commercial/Industrial/Institutional 1.25% of Value of Appliance or Work (List on Back) $ o Minimum Fee $35.00 for Commercial/Industrial/Institutional State Surcharge $ �O TOTAL FEE $r'' REINSPECTION FEE $50.00/HOUR �' J *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE +x 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 trueandcorrect. HEATING CO I 0 4\k Ln (VI F U, lIAfA N � Signed Tel # 7/rz�-��s(0 FAX # I0� S 57 t4 Date " 7 r� Approved by pug fy R h -in Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer 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 -LAMA 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 Taal 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) /S*kSc, (e0o tJ Sc,C 0<<1jC-- HEATING CO: bdk ° i Ces Signed By: Date :% City of Fridley 0706 S7 -n( V �s 6431 University Ave NE Fridley MN 55432 (763) 572-3602 or Fax (763) 502-4977 Water and Sewer Permit Application 6 New Connection ❑ Existing Date: '/±, do Job Address: %jn 2f�&/ Avba /W ❑Utilit Line Repair/Relocation ater nd Sewer Connection Name of Applicant (Plumber): !/ �� - rG c. Name of Property Owner: Existing Structure Permit # Permit Type: Sewer Fee: Water Fee: gyp . Dy Meter Fee: Repair Fee: Relocation: State Surcharge: , 56 SAC Charge: Special Assessment Fee: Total: $(50 • rj Applicant Signature: Inspector approval: Water Meter Repair — Weekend & Holidays $125/hour Water Connections Permit $50 Sewer Connections Permit $50 Inspection Fee for Water/Sewer Line Repair $40 Special Assessments See Engineering Cost of Water Meter See Utility Billing SAC Charge $1450 State Surcharge $ .50 Water Tap See Engineering 04/04/05 •OCT, 15. 2004 11; 47AM VALLEY -RICH CO INC 15 Riven- Rd rromo4e Act f"rO�SGCI Pew Gv's Avnor� ex AI dr2 q aid jol- ft 4elw, a4! (2 ) Uq& tA W%, Rt - in s4a 11 kyci s L yowaad A64(A cevAr 5-700 E, 1fIlAr -A0,24 Fr rd t7 NO. 895 P. 2 1. Avoca AYJAO. El JUL-29-2005 13:10 CITY OF FRIDLEY P.04iO4 ��C PLUMBING Per i ber Pe � COMMERCIAL APPLICATION . City of Fridley / Re �� By to Re ed � DATE — — 0S YOUR E-MAIL DRfE�SS k o 1` 1 a r� �WT `^ ` LO 1/4, 57-00 4e-4 �. ' ; � e ✓ AJ SS Lu SITE ADDRESS " TENANT SUITE NO. NAME PROPERTY OWNER! ADDRESS 5700 i TENANT CITY r: Z� e- STATE ZIP S ` PHONE # 712 - cS 71 - 31 S0 nIAME r�AkItAw"L`Ire- -LICENSE# �II�1SSY CONTRACTOR CITY �G^pOY „� �� k STATE " ZIP PHONE 7Z,3 a - ;)6 ti 6 FAX PERMIT TYPE INSTITUTIONAL Q MULTI -FAMILY O SWIMMING POOL O TOWNHOUSE Q COMM ERCIAL)INDUSTRIAL 0 OTHER TYPE OF WORK Q NEW 0 REPLACEMENT ALT./REMODEL DETAILED, DE1J DESCRIPTION rO�F WORK , "!!5 I "1.- o f .� o -C C K.�e-'1 FIXTURES: (INDICATE TOTAL NUMBER OF EACH) FEES BASED ON $10 PER FIXTURE, EXCEPT WHERE NOTED URINAL CLOTHES WASH FLOOR DRAINS RPZ VALVE) ($15) WATER HEATER ($35) DISHWASHER GAS PIPING BACKFLOW PREV. WATER METER DRINKING FOUNTAIN GREASE TRAP ROOF DRAINS �ITCHEN SHOWER WATER PIPING FAUCET SINK WATER SOFTENER ($35) FLAMMABLE WASTE LAUNDRY TRAY SLOP SINK WATER CLOSET TANK LAVATORY SWIMMING POOL — Permit Fee $ $35.00 Pian Review $ Surcharge $ • 5 $.50 on permits less than $1,000 Total Due $ 3`5 • 50 Make Checks Payable to: City of Fridley THIS IS AN APPLICATION FOR A PERMIT - NOT VALID UNTIL PROCESSED I hereby apply for a plumbing 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. / NAME OF APPLICANT ✓� r w v. DATE ` �S SIGNATURE OF APPLICANT CITY OF FRIDLEY COMMUNITY DEVELOPMENT DEPART) 6431 UNIVERSITY AVENUE NE, FRIDLEY, MN 55432 TOTAL P.04 .bul . Inspections 763-572-3604 DATE / /) / — SITE ADDRESS TENANT BUILDING Permit No.: ' _6a COMMERCIAL/INDUSTRIAL Received By: CITY OF FRIDLEY Date Rec'd: % ,5�6 YOUR E-MAIL ADDRESS Suite No. F� PROPERTY OWNER NAME: $ — 65% of Building Permit Fee $ ADDRESS: CITY STATE ZIP $ PHONE: $ $450 Conservation Plan Review ARCHITECT NAME: $ Agreement necessary ( ) Non Necessary ( ) ADDRESS: CITY STATE ZIP Make checks payable to: City of Fridlev Attach CONTRACTOR NAME:100_ ' r ADDRESS. \13r 0, Y %� cya CITYy STATE/IP S 6i PHONE: - FAX *NOTE: 7 L) CITY LICENSE REQUIRIED FOR MULTI FAMILY/COM_M­E'RCI4WPMJOBi PROPERTY TYPE ❑ TOWNHOUSE I] COMMERCIAL/INDUSTRIAL ❑ INSTqC7MNTL ❑ MULTI -FAMILY PERMIT TYPE ❑ ADDITION ❑ NEW CONSTRUCTION ❑ OTHER ❑ REMODEL ❑ ROOF ❑ SWIMMING POOL PLEASE SUBMIT: 1. 4 SETS OF DRAWINGS 5. CONTRACTORS LICENSE OR 6. SPECIAL INSPECTION 2. SURVEY/SITE PLAN LICENSE APPLICATION SCHEDULE 3. LANDSCAPE PLANS 7. PERFORMANCE BOND 4. ENERGY CALCS AMOUNT WILDING TO BE USED 'n'rA T QT7U. AS: OFFICE SF WHS sF OTHER SF THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in onformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a ermit but only an application fo permit Pdwork is not to start without a permit; that the work will be in accordance with the approved Ian in the case of all workwh> �6qui�j w and approval of plans. IGNATURE OF APPLICANT ALL 11 PRINT NAME e k� G ` 5ATE AKI; BA5SED ON VALUATION Sq. ft. x $ Cost/sq. ft. = Valuation $ Sq. ft. x $ Cost/sq. ft. = Valuation $ Sq. ft. x $ Cost/sq. ft. = Valuation $ TAL JOB VALUATION: $ ,� USE OCCUPANCY TYPE nut Fee n Review Surcharge rcharge C Charge sion Control k Fee cial Assessments b Cut Escrow al Due $ See Back Page for Fee Schedule $ — 65% of Building Permit Fee $ .001 times the total job valuation $ .0005 x Permit Valuation Minimum $.50 $ $1550 per SAC Unit (Plans to MWCC for determination) $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ ft + 6 ft = ftx$20=$ $ Make checks payable to: City of Fridlev Attach -fi 35. av 1 ations AN 71:�S m Q)Q =7 Protecting, Maintaining and Improving the Health of Minnesotans December 14, 2005 Mr. Michael Tennison Executive Director Lynwood Healthcare Center 5700 East River Road Fridley, Minnesota 55432 Dear Mr. Tennison: I am writing in response to your letter, dated October 10, 2005, regarding a proposal to construct a kitchenette in a dining room in the west wing of this facility. According to your letter, this kitchenette would be used for occupational therapy. The layout that was transmitted your letter indicates that this dining room is open to the corridor, i.e., the dining room is not separated from the corridor by a rated full -height partition. Under certain circumstances, use areas may be open to the corridor. Please refer to National Fire Protection Association Standard 101 (Life Safety Code, 2000 edition), 19.3.6.1, and exceptions. Generally, exception #1 is used, however, it is not permissible to have treatment areas open to the corridor. Since occupational therapy is considered a treatment, it is not acceptable to construct the kitchenette in this area. If the facility constructed a properly rated corridor wall to separate the dining room from the corridor, the construction of the kitchenette may be acceptable. The new wall could include the installation of a set of single egress doors that are held open by magnetic hold -open devices. This would allow the dining room to remain essentially open while at the same time be in compliance with 19.3.6.1. During a telephone conversation this morning, I advised you to review the required exiting from this area of the building with the State Fire Marshal. The layout indicates that both doors leading outside from the dining room are considered exits. These doors may not be required exits and it is in the facility's best interests to treat them as such (not required). On the other hand, if the dining room measures more than 2500 square feet, two exits are required. Please refer to NFPA 101(00), 19.2.5.3. In this case, access to the corridor and to the hinged door leading to the outside must be maintained within the dining room. In conclusion, with construction of a complying corridor wall and a review of the exiting from this area of the building (accompanied by required modifications) it may be possible to construct General lntormation: (651) 215-5800 • TDD/TTY: (651) 215-8980 • Minnesota Relay Service: (800) 627-3529 • www. health. state. mn.us For directions to any of the MDH locations, call (651) 215-5800 • An Equal Opportunity Employer . Michael Tennison ,ynwood Healthcare Center Page 2 the kitchenette. If, upon further review, the facility decides to proceed with this project, please submit revised layout and letter for review and approval. If you have any questions concerning this matter, please contact me. _ Sincerely, J mes P. Loveland, P.E. rogram Manager Engineering Services Section Compliance Monitoring Division Telephone: (651) 215-8738 Fax: (651) 215-8710 JPL;jpl Cc: J. Gergen - SFM _ J. Loveland - File Building - Inspections 763-572-3604 DATE I -�5 / — SITE ADDRESS ` S-ZA91 �ll10-0 —M PROPERTY BUILDING Permit No.:_� COMMERCIAL/INDUSTRIAL Received By: CITY OF FRIDLEY Date Rec'd: 7 YOUR. E-MAIL ADDRESS ADDRESS: PHONE: Suite N CITY STATE ZIP ARCHITECT $�(, ,p'Z j NAME: Plan Review ADDRESS: CITY STATE_ZIP Fire Surcharge C NTRACTOR .001 times the total job valuation NAME: t' � SAC Charge ADDRESS: `0 ti CITY '!�%i STATEZWIP -� � 0 $ PHONE: 9 J62 2eya /CJI - FAX / Fee Determined by Engineering *NOTE: CITY LICENSE REQUIRED FOR MULTI FAMILY/COMMERCIAL/INDUSTRIAL JOBS PROPERTY TYPE Agreement necessary ( ) Non Necessary ( ) ❑ TOWNHOUSE In COMMERCIAL/INDUSTRIAL ❑ INSTITUTIONAL ft + 6 ft = ft x $20 = $ Total Due ❑ MULTI -FAMILY Make checks payable to: City of Fridley Attach Stipulations PERMIT TYPE ❑ ADDITION ❑ NEW CONSTRUCTION ❑ OTHER ❑ REMODEL ❑ ROOF ❑ SWIMMING POOL PLEASE SUBMIT: 1.4 SETS OF DRAWINGS 5. CONTRACTORS LICENSE OR 6. SPECIAL INSPECTION 2. SURVEY/SITE PLAN LICENSE APPLICATION SCHEDULE 3. LANDSCAPE PLANS 7. PERFORMANCE BOND 4. ENERGY CALCS AMOUNT $ BUILDING TO BE USED AS: OFFICE SF WHS sF OTHER SF TOTAL SIZE: STORIES F S OTE TIONY/N) AC(Y/N) DETAILED DETIQN OF �O 62 k THIS IS AN APPLICATION FZSR 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 fo permit pd work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all workw qu' iew and approval of plans. l / SIGNATURE OF APPLICANT c PRINT NAME G° ATE ALL FLFPS ARE BASED ON VALUATION Sq. ft. x $ Cost/sq. ft. = Valuation $_ Sq. ft. x $ Cost/sq. ft. = Valuation $_ Sq. ft. x $ Cost/sq. ft. = Valuation $_ TOTAL JOB VALUATION: $,_20LQ0.00 USE OCCUPANCY. TYPE Permit Fee $�(, ,p'Z j See Back Page for Fee Schedule Plan Review 65% of Building Permit Fee Fire Surcharge _$ $ 17-6 .001 times the total job valuation Surcharge $ J .0005 x Permit Valuation Minimum $.50 SAC Charge $ $1550 per SAC Unit (Plans to MWCC for determination) Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Special Assessments $ Agreement necessary ( ) Non Necessary ( ) Curb Cut Escrow $ ,� ft + 6 ft = ft x $20 = $ Total Due $ D . Make checks payable to: City of Fridley Attach Stipulations .) vv 0-� -r�CD -P, I t�\x 3 odo1l°1r --ps -? Aq4 e," A j3s� eta -?rc/j -Z�,q jood "31 cn I ,l q i ,is 1 � -/ n ��-��p �► six 1 Protecting, Maintaining and Improving the Health of Minnesotans December 14, 2005 Mr. Michael Tennison Executive Director Lynwood Healthcare Center 5700 East River Road Fridley, Minnesota 55432 Dear Mr. Tennison: I am writing in response to your letter, dated October 10, 2005, regarding a proposal to construct a kitchenette in a dining room in the west wing of this facility. According to your letter, this kitchenette would be used for occupational therapy. The layout that was transmitted your letter indicates that this dining room is open to the corridor, i.e., the dining room is not separated from the corridor by a rated full -height partition. Under certain circumstances, use areas may be open to the corridor. Please refer to National Fire Protection Association Standard 101 (Life Safety Code, 2000 edition), 19.3.6.1, and exceptions. Generally, exception #1 is used, however, it is not permissible to have treatment areas open to the corridor. Since occupational therapy is considered a treatment, it is not acceptable to construct the kitchenette in this area. If the facility constructed a properly rated corridor wall to separate the dining room from the corridor, the construction of the kitchenette may be acceptable. The new wall could include the installation of a set of single egress doors that are held open by magnetic hold -open devices. This would allow the dining room to remain essentially open while at the same time be in compliance with 19.3.6.1. During a telephone conversation this morning, I advised you to review the required exiting from this area of the building with the State Fire Marshal. The layout indicates that both doors leading outside from the dining room are considered exits. These doors may not be required exits and it is in the facility's best interests to treat them as such (not required). On the other hand, if the dining room measures more than 2500 square feet, two exits are required. Please refer to NFPA 101(00), 19.2.5.3. In this case, access to the corridor and to the hinged door leading to the outside must be maintained within the dining room. In conclusion, with construction of a complying corridor wall and a review of the exiting from this area of the building (accompanied by required modifications) it may be possible to construct General Information: (651) 215-5800 • TDD/TTY: (651) 215-8980 • Minnesota Relay Service: (800) 627-3529 • www. health. state. mn.us For directions to any of the MDH locations, call (651) 215-5800 • An Equal Opportunity Employer Mr. Michael Tennison Lynwood Healthcare Center 'Page 2 the kitchenette. If, upon further review, the facility decides to proceed with this project, please submit revised layout and letter for review and approval. If you have any questions concerning this matter, please contact me. Sincerely, Ql�yac.� J mes P. Loveland, P.E. rogram Manager Engineering Services Section Compliance Monitoring Division Telephone: (651) 215-8738 Fax: (651) 215-8710 JPL;jpl Cc: J. Gergen - SFM J. Loveland - File Fn ,� s ej G dG 7 bYt �2 Ht Building PLUMBING Permit No.: Inspections COMMERCIAL APPLICATION Received Byr:/C-'Q.' 763-572-3644 CITY OF FRIDLEY Date Rec'd: / DATE '9 - I 1 'd (-10 YOU E-MAIL ADDRESS SITE ADDRESS e iP TENANT J Uz 06 f(^ SUITE NO. PROPERTY NAME: ADDRESS: CITY STATE ZIP OWNER/ TENANT PHONE: CONTRACTOR NAME: NORTHLAND MECHANICAL CONTRACTORS, INC STATE LICENSE # 3957 PM EXP DATE 12/31/06 SUBMIT A COPY OF YOUR STATE ADDRESS: 9001 Science Center Drive CITY New Hope STATE MN zip- 55428 LICENSE WITH PHONE 763-544-5100 2,X35 FAX 763-544-5764 APPLICATION PERMIT TYPE ❑ INSTITUTIONAL ❑ MULTI -FAMILY ❑ SWIMMING POOL ❑ TOWNHOUSE 'IQ o_ VP.IERCIAL NDUSTPIAL 0 OTHER TYPE OF WORK: ❑ NEW LACEMENT ❑ ALTERATION/REMODEL l DETAILED DESCRIPTION OF WORK �,p to-(! (� BUD r �! al l " SSC) 4t &1f 4 c )a FlXrURES (INDICATE TOTAL NUMBER' OF /;ACM, FES EXFIXTUI ,EXCEPT WHERE -NOTED. CLOTHES WASHER FLOOR DRAINS RPZ VALVE/ ($15) URINAL _ _ _ — DISHWASHER _ GAS PIPING BACKFLOW PREY. A WATER HEATER ($35) DRINKING FOUNTAIN GREASE TRAP ROOF DRAINS _ WATER METER FAUCET KITCHEN SINK SHOWER _ WATER PIPING FLAMMABLE WASTE TANK _ LAUNDRY TRAY — SLOP SINK _ WATER SOFTENER ($35) LAVATORY SWIMMING POOL WATER CLOSET Permit Fee $ -7c). D Minimum: $35 Pla« Review $ Surcharge $ , SC) $.50 on permits less than $1000 Total Due $ 7D . SZ) Make Checks Payable to: City of Fridley 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 cas f all wor hi requires review and approval of plans. NAME OF APPLICANT DATE SIGNATURE OF APPLICANT PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR BUILDING, ELECTRICAL AND MECHANICAL WORK City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 City of Fridley Building Inspections Dept. 0 Ph: 6431 University Ave NE Fridley MN 55432 Mechanical Commercial Application City of Fridley 04g9 18J(L 763-572-3604 FAX: X763-571-1287 Permit # �� 'o� 50 -«-t�e Date'R -(j - r, I, Site Address: 766 474 a 1- A` X The applicant is: (cirice one) Own Contractor Architect/Engineer Property Owner: LV j N ! 'In r + "r a f/ a 4' .:.ry Address: 4-r i P,,( ktj City: F.,, i tr-,-4 State: Zip: Phone: Cell: Fax: Contractor Information Company Name: NORTHLAND MECHANICAL CONTRACTORS, INC. Contact Person: --T'e rt k +/ 40kAl Address: 90(11 Srianra rpntpr nrive City: New Hope State: MN Zip: 55428 Phone: 763-544-5100 Cell: LID 36r, 56 s Fax: 763-544-5764 Email: MN Bond# & Exp Date 00144 Permit Type (circle one): Multi-faMily�Com--me� Institutional Condo building 8/15/06 Industrial building Swimming pool Other: Type of Work (circle one): New Replacement Alteration/Remodel Detailed Description of work: Gd" �'. a"i. t`'} Equipment Installed: MFG: r Model: C .s �., Size/BTU: MFG: Model: Size/BTU: MFG: Model: Size/BTU: Please check all that apply: _Duct Work _Roof Top Unit (RTU) C Furnace Refrigeration ler KB Gas Dryer Steam/Hot Water Heat ass I Hood _Gas Piping Swimming Pool sT,-mnnrP.r%/ Class II Hood _(_ac 1 Init Haat_cr Heat Commercial Kitchen Pool Heater Other All fees are based on valuation, including the cost of labor and materials: Total Job Valuation: $ w(li, .,*Y^ , e-) P Permit Fee $ r P (1.25% of Job Valuation / Minimum fee $35.00) Surcharge $ 0 Valuation X.0005 Total Due $ .0i) Make check payable to City of Fridley This is an application for a permit- not valid until processed I hereby apply for a mechanical 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 appr=1' of a I work which requires review and approval of plans. Signature of Applicant:,\• -r-, / _ Date: Approval Inspector Sign Please Note: Separate permits are required for Building, Plumbing, and Electrical work Revised 6/14/2005 CITY OF FRIDLEY SIGN PERMIT APPLICATION 6431 University Ave NE Fridley MN 55432 763-572-3595 FAX 763-571-1287 Owner: 0 1 r ' At -S Address:'6 200 '�y City/Zip: mh 557i/j Z Tel. No:'(' - S Address: LENGTH jS"l{ J 1 j N 12 2007 Effective 4/1/2004 -6) cw4 Sign Erector: Address: City/Zip: 1/ /YI ld,�&!�/7"%f'I S5-30' Tel. No: %(1l %ff Ll- %-;�(YZ Zoning P ), HEIGHT 7�I/ SQUARE FOOTAGE e/ ( ) Wall; Length of Wall J4 Pylon; Setback from property line ( ) Roof; In Lieu of Pylon Sign SIGN MESSAGE: Constructed Of: Illuminated: YeNo Allowable Sq Ft From Driveway Off Ground Estimated Value $ 9:50 ) IF YES, Electrical Permit Necessary to Wire Sign 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 Planning Division and hereby declares that all the facts and representations stated in this application are true and correct. DATE: '5-9-0;; Permit Fee Surcharge TOTAL' a% APPLICANT $350.00 - Each permanent sign - All sizes Add $.50 surcharge if sign is NOT lit CITY OF FRIDLEY SIGN PERMIT REVIEW Complete Review Checklist� Address: �, File Date: � � � V�.r Due Date: (,,p I Return to Building Inspection Stacy Stromberq D� ''rulvu"v +n�/X t Julie Jones Jon Haukaas Ron Julkowski Don Abbott "A Comments: CA) kAtov) ► v �� ►� CIM 0 G kx, l a Ft WV0 Existing Sign #: 1 Fritting Sign #: 2 Proposed Sign #: 2 Illum. ❑ Non Illus. ❑ SIF ❑ DIF ❑ Ilium. ❑ Non Illum. ❑ SIF 0 DIF ❑ H NA W NA D NA OAH NA H 3'-4' W 12'-0' D NA OAH NA Note: Note: Exterior Ligl%ing - Ground Flood Light Note: El 2 eu I RFACE I MATCH 37 YELLOW 2935 BLUE MN -P-8 / D.F. Non -Illuminated Post & Panel Monument Sign 1 _Scale: 1/4"=1'-0° IXY: 1 NOTE: NEW SIGN TO BEE%TERNALLY ILLUMINATED WITH FLOOD LIGHTS UTILIZING EXISTING ELECTRICAL SERVICE. Existing Sign #: 3 Ilium. ❑ Non Illus.❑ SIF ❑ DIF ❑ H NA W NA D NA OAH NA Note: Eo21 114' 1 RFACE MATCH 17 YELLOW 2935 BLUE Door Vinyl Door Vinyl Sign 1 Scale: 1/2"=1'-0" Sign 3 Scale: 1/2"=1'-0" Oly: 1 Qty: 1 ( \ LOCATION: 971-881 / Lynwood FILE: 971-881_Fridley MN PAGE: 3 of 3 REVISED: 10/24/06 PMF 02/28/07 PMF t ) € l d e n g 1918E/mhuruRA enenters 5700 E. River Road DATE: 10/11/06 SCALE: As Noted y� E/k Grog �ala� livingc Fridley, Minnesota 55432 ORRYM: NP DIRECTOR: O a r r•11 /11nos60077 , LEGEND ACTON ACTION CODES } = OVERVIEW PHOTO R REPLACE - SIGN X = REMOVE C = CUSTOM � f< BUILDING L = LEAVE BU PROPERTY LINE N - NEW �v - -. +5 - + '• 172iT RAIL ROAD fr FENCE r i t R s� r y' Y '+` IMPORTANT APPROVAL NOTIFICATION ' + 4 ' t� - r Please review the recommendations shown to determine flair rY,.,t_.•r �. 02 compatibility to be installed awith the nd note anitions fthe location in which charges. Your signature P Y _ y N —�O -� � ys accurate arid ecceptablreval fo of the to recommendations conditions. The colors styles and graphics shown on this page have been developed 0 from artwork and information supplied by CERES PURCHASING SOLUTIONS. Please review them carefully to determine their ��:. #�. "A' • i. ;.. _ 03 , • ti accuracy and note any changes required before your approval, as . tla projectwill be produced as approved. Once approval has been received, you will be held financially responsible for any additional changes or adjustments to the ' ..► r A c\'iY�7j recommended signage. - Authorized Signature: tnT 4 r Print Name: •, % Date:_ $« ❑Approvedasshown ❑Approvedwlchangesnoted . j. r - CUSTOMER NOTE: SIGNAGE WILL BE MANUFACTURED & SHIPPED ONLY AFTER PERMITS ARE OBTAINED FROM SUBCONTRACTOR. .ar , - mar r. - r { ✓..� a THE LOCAL CONTACT IS RESPONSIBLE FOR PRIMARY ELECTRICAL SERVICE TO THIS LOCATION, IF ANY EXISTS. ALL OLD SIGNS WILL BE REMOVED AND DISCARDED. LOCATION: 971-881 / Lynwood FILE: 971-881—Fridley MN PAGE: 1 Of 3 REVISED: 10/24/06 PMF 02/28/07 PMF 5700 E. River Road DATE: 10/11/06 SCALE: As Noted 1 C o y� £ik C o e urti r _ ivi ng centers Fridley, Minnesota 55432 DRAWN: NP DIRECTOR: 11 //linois 807 � ,�. FROM :CROSSTOWN SIGN FAX IJO. :7637849753 Jun. 08 2007 12:33PM P2 FEg7 ar a .a tv , i �Pey r�� �Q SY y.4 NIP! ON St Nf All r p-� 6ON(BLOCK i . �4' o 5.f •N4 DDW �WLL - 0$ '1- - - - ,O lo --------------- QUS -FWND RAIL OF ROAD ci p S 4te Building BUILDING Permit No.: - Inspections COMMERCIAL/INDUSTRIAL Received By: 763-572-3604 CITY OF FRIDLEY DatDd:A Uri - DATE Al C1 -�C�--' / YOUR E-MAIL ADDRESS SITE ADDRESS TENANT Suite No. PROPERTY OWNER NAME:L'2e-x- C ejw L t ✓/Nf y �e T=R — & ADDRESS: 0%0i 0451 �UM ITY JMSYSTATE�`IKZIP 2, Erosion Control $ PHONE: ARCHITECT p q NAME: M 1- T t 1T ADDRESS: Zy43 N0z*A Ll ax-tC CIT p6&,h to STATEMAZIP 'SSI 1 '7 Special Assessments CONTRACTOR NAME: -4 A%05-c�,,S2-0 Curb Cut Escrow ADDRESS: I X1001 R%bhEQ A 2 LO- I�CITY VA NNO: t . STATE WIMP S� ft + 6 ft = ft x $21 = $ PHONE: qsz - 6;.45- 2-0 3!9- FAX ' S Z - C`I 3- 2 S $3 $ *NOTE: CITY LICENSE REQUIRED FOR MULTI FAMILY/COMMERCIAL/INDUSTRIAL JOBS PROPERTY TYPE ❑ TOWNHOUSE ❑ COMMERCIALANDUSTRIAL STITUTIONAL ❑ MULTI -FAMILY PERMIT TYPE ADDITION ❑ NEW CONSTRUCTION ❑ OTHER ❑ REMODEL ❑ ROOF ❑ SWIMMING POOL _ I LEASE SUBMIT: 1.4 SETS OF DRAWINGS 5. CONTRACTORS LICENSE OR 6. SPECIAL INSPECTION 2. SURVEY/SITE PLAN LICENSE APPLICATION SCHEDULE 3. LANDSCAPE PLANS 7. PERFORMANCE BOND 4. ENERGY CALCS AMOUNT $ BUII,.DING TO BE USED AS: OFFICE SF WHS sF OTHER SF TOTAL SIZE: STORIES FIRE PROTECTION (Y/N) AC(Y/N) DETAILED DESCRIPTION OF WORK "1d)c)- M AAD'?II>N Tt* >L.VL.40.r'.9� Ct INMP-10 f- ��•.wcoD 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 wo is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work whi Tres re d approval of plans. SIGNATURE OF APPLICANT PRINT NAME ` HR) S Nom- DATE l �Z>J- ALL FLEES ARE BASED ON VALUATION Sq. ft. x $ Sq. ft. x $ Sq. ft. x $ TOTAL JOB VALUATION: S I j n OJIN Cost/sq. ft. = Valuation $ Cost/sq. ft. = Valuation $ ft. = Valuation $ _ OCCUPANCY tea-- TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 1,4, 65% of Building Permit Fee Fire Surcharge $ fl,o , ci .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 SAC Charge $ $1675 per SAC Unit (Plans to MWCC for determination) Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Special Assessments $ Agreement necessary ( ) Non Necessary ( ) Curb Cut Escrow $ ft + 6 ft = ft x $21 = $ Total Due $ 3 (f/ Make checks payable to: City of Fridley Attach Stipulations 3�, cc -,J:4L . -- 40 CfIYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 (763) 571-3450 • FAX (763) 571-1287 • TTD/TTY (763) 572-3534 CITY COUNCIL ACTION TAKEN NOTICE November 7, 2007 Mark Pope RLP Architects, Inc. 2443 Farrington Circle Roseville MN 55113 Dear Mr. Pope: On Monday, November , 2007, the Fridley City Council officially approved Special Use Permit, SP #07-10, to allow a nursing home to continue to exist, and to allow a nursing home to continue to exist, and to allow an expansion of the nursing home in an R-3, multi -family zoning district, generally located at 5700 East River Road. Approval of this special use permit is contingent upon the following stipulations: 1. The petitioner shall obtain any required permit prior to the start of construction. 0L 2. The subject property shall be maintained free of any and all construction debris. OVI ty" IY19 3. The addition shall be architecturally compatible with the existing building and finished with complementary siding and color scheme. c �' 4. The City reserves the right to require additional parking should the demand of the facility warrant it. WV - (T i r V) 5. Landscape plan shall be reviewed and approved by City staff prior to issuance of a building permit. - v1U� �(wwv► v}. ��6�, 416 V1 )(_01i 11"W[k Wo Vl �0 6. The petitioner shall submit a grading and drainage plan to be approved by Cit engineering staff prior to issuance of a building permit. 41AH'U"J rU BVI VI�Piyj � 0 �r I 5 �J Also, on Monday, November , 2007, the Fridley City Council officially approved a Variance, VAR 07-04, to reduce the front yard setback from 35 feet to 13.1 feet to recognize an existing non -conforming setback, and to reduce the side yard setback on the north side from 15 feet to 9.6 feet to reduce the side yard setback on the south side from 15 feet to 12.8 feet, which will allow for the construction of a 510 square foot addition to the existing building, generally located at 5700 East River road. Approval of this variance is contingent upon the following stipulations: 1. The petitioner shall obtain any required permit prior to the start of construction. e 2. The subject property shall be maintained free of any and all construction debris.,,, 11G 3. The addition shall be architecturally compatible with the existing building and finished with complementary siding and color scheme. �. (. 4. The City reserves the right to require additional parking should the demand of the facility warrant it. OrI y �(t� 5. Landscape plan sha j/ be reviewed and approved by City staff prior to issuance of a building permit. ' �A1 l V Uj K 1 r M If you have any questions regarding the above action, please call me at 763-572-3590. Sinc ly, tt is mmuni y Development Director SH/jb cc: Mike Marchant - Golden Living Center - Lynwood Address File Tina Beckfeld Stacy Stromberg C-07-52 Building PLUMBING Permit No.: 2067`6a f Inspections COMMERCIAL APPLICATION Received By: BRAE C 1 200 763-572-3604 CITY OF FRIDLEY DATE. ZJ W 10 -7 YOUR E-MAIL ADDRESS R-(ve D t ik5�ia<<aTi� Mr[ I�Antl SITE ADDRESS S700 12-1 VeFF- R_A TENANT owwoor, 4t-:-:PITH C4kiz-r_- SUITE NO. -' PROPERTY NAME; Wipy ADDRESS: CITY STATE _ZIP OWNER/ TENANT PHONE: CONTRACTOR NAME: 1 1 mc- STATE LICENSE # PM 2J�2q 2, EXP DATE 12- SWA.ILQPEV_- STATEMh ZIP SS319 SUBMIT A COPY OF YOUR STATE ADDRESS: 1 C;-7 fAAR6c a4A-lA, (Zl" CITY LICENSE WITH PHONE.957- 4+5 Slog FAX 0152.- �F�}CJ 5 1101 APPLICATION PERMIT TYPE ❑ INSTITUTIONAL ❑ MULTI-FAMILY ❑ SWIMMING POOL ❑ TOWNHOUSE ❑ COMMERCIAL/INDUSTRIAL OTHER ❑ NEW ❑ REPLACEMENTALTERATION/REMODEL TYPE OF WORK: DETAILED DESCRIPTION OF WORK —9 �AbD M 0r 'TD 0W� i 1 rJ tea uT �� FIXTURES: (INDICATE TOTAL NUMBER OF EACH) CLOTHES WASHER ( FLOOR DRAINS _ RPZ VALVE _ URINAL _ DISHWASHER _ GAS PIPING BACKFLOW PREY. _ WATER HEATER _ FOUNTAIN _ GREASE TRAP _ ROOF DRAINS _ WATER METER -DRINKING FAUCET 1 KITCHEN SINK I SHOWER -WATER PIPING _ FLAMMABLE WASTE TANK LAUNDRY TRAY _ SLOP SINK _ WATER SOFTENER _ _ LAVATORY _ SWIMMING POOL WATER CLOSET Total Job $ ((),Doo All fees are based on valuation, including the cost of labor and materials. Valuation Permit Fee $ 17-S (1.25% of Job Valuation / Minimum fee: $35) Surcharge $ 5 Valuation X .0005 Total Due $ (317 Make Checks Payable to: City of Fridley 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. P � 00'D (N DATE I ? I �� NAME OF APPLICANT SIGNATURE OF APPLICANT PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR BUILDING, ELECTRICAL AND MECHANICAL WORK City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 DY o- I ON TO SHOWER 1 S lEEjn` ' -.-_�1� r r i HNOINEERINO SSTK 1 l 6 EIOSTNG SA gANt ON T SHOO t ,yax ON TO WOMEN t u1YNG 751 J� BOP 98 3 II I �I MECHANICAL SYMBOL SCHEDULE ♦M ... ,y r %!""I /7''^-/�r°� XMA_ .... /� ,F II Qd6d. OEBCFPRW BIBd. 0119CIP11714 9Y\BOL onLTMBBC6 uei t HW TO SINK mdTu a1X ROD . Z. Sul iurr>fAW1 --g' vuKw WRnCN. tw - ) WI.Tm WMM.F^aux W9NItlN0 VIL'h CM OOYwI Nd[M CR WNL NWMMNi RF VMWx9 RKW FIFVAnm _ J 9mw Lp N mN1UAE IR1118 PENETRATION TO NEW LOCATION I. ROOF TE- 1 . Meow ooxr� w xm M1tR k HW TO IAV RELOCANITOHEN HOOD EXHAUST DUCT Q MMxECT TO Dn6nx6 _ sxµW � ��� IUV,� Wl�IB / mmn BrvAnox Overt _ M,wWax,axr vm WNT TIw Wd:r ,In �W = �aFAn arrT wm vu crew-inotc wax J R-XX oox wATn Mme srTeoL _r� I I W-XX wAsS Man sreHx. muT dMxnax �_ sw zren-ndaw aMx I I I r L_.... wAa tw wAm m'4nllcwmPXO(uwr°Ruxq v. iLtBlO mNwAxs Mux tR.w wIT i 1 ®t0 Maax awn x- dx®nc wn wAtm a xum wo wATu � � wmwu nAa wATm dMd vuAE e1w owWanc xm wxwR (���'�, rwT N name m,>a 'n Wn GENERAL NOTES A ALL WORK THAT REQUIRES INTERRUPTON OF THE EXIBTING MECHANICAL SYSTEMS SHALL BE CWMCINATED WITH THE OMER, B. EXISTING MECHANICAL SMOMN NGHT COLORED.MECHANICAL ITEMS TO BE DEMOLISHED ARE SHOWN DARK COLORED.CROSSHATCHING,WHEN SHOWN,INDICATES HEMS TOBE REMOVED. 1 -- ---l Ij r C. NOT ALL DOSING EWPHENT,PIPING,CUCIWORK,M.IS SHOMN ON THE PLANS, FIRST FLOOR AL1 EXISTING EWIPMENT ANO PIPING SHORN DOES NOT REFLECT ALL OFFSETS, IEiCTHS AND LOCATONS. PLUMBING PLAN C. THE INTENT IS TO REMOVE ALL UNNECESSARY EASTNG PIPING AND DUCTWORK THROUGHOUT �$ —O ,tel CONSTRUCTION AREA.EXISTING DUCTWCRK AND PIPING LOCAT10NE SHOWN ARE APPROXIMATE ANO IT IS THE COMTRACTOR'S RESPCNSTBILLTY TO FTED VERIFY EXACT ExTENT OF DEMWTCN II NECESSARY.PIPING/gICTIRC SHOWN TO BE RENOV AND NOT RECONNECTED OR EXTENDED FROM SHALL BE REkOVED BAC(TO MAIN AND CAPPED AND SEALED AIRTIGHT. E. CONTRACTOR IS RESPONSIBLE FOR REVEWNG AND COORDINATING MYTH ARCHITECTJRAL - PLANS. VERIFY ALL MISTING CONDITIONS ON JOB SITE PRIOR TO CONMENCNG ANY F. COORDINATE W/ARLHIIECT THE LOCATONS REWIRING SAWCUTTNG OF FLOORS AND REMOVAL OF WANNGA G SYSTEMS. MAMATERIAL AND INSTALLATION SHALL MEET STATE AND LOCAL CODES L i; _ H. DRAWINGS ARE DIAGRAMMATC AND ARE INTENDED TO SHOW f f ILII' APPROXNATE LOCATIONS ONLY.THE CONTRACTOR SHALL THOROUGHLY RENEW ALL ARCHITECTJFA.STRUCNRAL AND -- -- - {l ELECTRICAL DRA'WN(S AND SPECFlCATONS, SPECIFIC NOTES J OSAW CUT THE FLOOR AND OPEN THE CEILING AS REQUIRED TO MODIFY EXISTING =-- HOT AND COIR DOMESTIC WATER AS WELL AS SANITARY AND VENT PIPING AS AND TO INSTALL NEW FIXTURES.REMOVE ALL CONCRETE,EXCAVATE, MODIFY EXISTING SANITARY PIPING,BACKFILL AND COMPACT AND REPLACE { CONCRETE TO MATCH EXISTING, L ILLL L� Jan,31. 2008 8:31AM ASSOCIATED MECHANICAL ' Jan -28. 2008 11:28AM ASSOCIATED MECHANICAL FROM :City or Frid City of Fddl•Y IS 8431 UnlYeWty pFdley MN 0541 Equlpmer PleaseK:h AI! f�a; AI Permil Pe Surcharg( Wei Que Approval please I "evledd FAX NO. -7635711207 No. 6821 P, 2 No. 6723 P. 4 Jan. 24 2008 08:3%1 P3 CID J AN 2,-8 2000 Ig Inapeolloon baps. Ph: 763.57e-av FAx: 7e2-gy9.13e7, NE @C1. 1C l Darrell n.I commercial Application City of Fridloy byte Addrells: v " one Owner nlr Ar Ile n a Y L — Mate: zip:��,r L.! h ' �µr �� State: • �:_ � �� _0049 001(: % ax: (clrcle one): Mul nduetrlal bulldirig Pali lnt(ltuflortal 00110o bV Iding MFIR'_ Model:: MFdF — —_ — Mrydel:• 'k atl that apply: Y Duct Work 'Furnace 81zolRTU:�� Roo! TOp unit (a7U) Re"frlgeratlon Gas Dryer ,_81aamMot Water Hest ^i0tsd Gas Piping_SwiMdling Pool Repd (oas britt H88lne _,Temporary Heol'E, babol on vawa ►nn, Incivaing me tiuo Pr Itluu, P11U {IIG1G olo. TalalJob Valuallon:6 f . (t.25% of Jab V®lu lion 1 Mlnh*6um fee $95.00) is .2n VeluatlonX.0006 ld tilt ppp 00 rip for a permll- not valla until processeu I hereby apply fora Modo od, pump and I edraoyrteQj (hal 0j iaformPAan above IR complete and o urrele; UW Ihewak Wittbe In ronformeno Vi h aha oniftres and ceass of 1he 011y of NdlAY grid whh (he Mrnnbso(a Cohr(n(adon oodel, (hal 1 underalertd Wit Is nol a parrNi but ottly on epplleellm far a permitandwoM le nbl W 61UNIM0u1 apermi; lutthe workQ he In ravadr4e110 WWI the Oproyed qpl. In eql of mi work wNoh requites reuiaw and Approval Of P, Aft Applicant- Dater powis are required for Building, Plumbing. and F-100111 el work . , Ir El UIPMENi SCHGDULC plplpl��\ C �-- t` '��- �) � IY (� ✓ flANI BROAN� 503E 005 150 z20V 42 10 48000 1150fp IX%ST 0 ENING — 02 A 500 F JryIIIryI�I' DUGTn�yI �� J=� I..� �TOHftUP VIII� 1yI,IIIIfIII�I1rTS LAIEa-_l�P �� 8 R �Lj PEEZ CCC000 9" ��� THRU R00 �71/ R 7 �o IIS - ;b ix 18X18 CFM SA 1100 RTU-1 INSULATE CURB r e fg1% s� M7 SCA MECHANICAL PLAN 57 I Jan.28. 2008 11:28AM ASSOCIATED MECHANICAL No.6723 P. 4 FROM :City or Fridley City of Fridley e 8431 Univerl FMdley MN 554! Pr6party FAX NO. :76357112e7 Jan. 24 2Ma OB:39AN P3 RECD JAN 2.8 2008 ig Inspectlone Dept. Ph: 763572-3844 FAX: 763-571-128' NE Mechanical permit #l"�', X%017 Is: contact Po on Address:S _. ,e Email: Permit commercial Application City of Fridley Site Addre's, ane Owner antra Architet:tlt±n in8ar 5 _ state:___— zip• Cell, Fax: PL r _ State:�✓,,.� Zip: -� -_'/00 Cell,- ax; (circle one): Multi -family building Swimming pool Inetltutionell Condo building Other: L_ t{uipment nstalted' MFC:,_[. j Model: 8lz b I u' SizelBTU: MFG: MFG: Model: Model: Size/KU' Please che ck all that apply: Duct Work Roof Top Unit ORTu) —pic Furnace Refrigeration ^Steam/Hot Water Heat —Boller Gag Dryer Claee I Mood Gas Piping Pool Temporary Heal Class I Hood Gas Unit Hmeter Other —Coram reial Kitchen All fees ar baeed on valuation, Ineiu Pool Heater ng—the-costoabor en materials: Total Job Valuatlon: $ Permit FallS l (1.25% of Job Vail tion 1 Minimum fee $35.00) C P,77 n Valuation X .0005 9� L Slgnalur( V Approval Please Note: Revised 6114 hie lean tappllcat[on or a permit- notvaild until processed I hereby apply for a mechanical perfrilt and I ecknoyrledga that the Intorm4lina above is complete and eaeurMe; that thework will be In conformance with the ordUtan❑es and cones or the City or Fridley and with the Minnesota Gonstnlc114r1 Code*; thar I underatand this is not a permit but only an applicatlon for a permit and work is not to Gtart without a permit; chat the work will be In aoWdeno0 Whlt the pProyad pign In cane or all work which requires review and approval or plans. Applicant= "✓ Date: apector Slgnature: 5�� permits ate ate required for Building, PlumblCtg, and Fzlectrical work reb, 0. LUDO 1 41AM AJJUUTAItU MLOAMAL UNIT No. FAN -1 FAN -2 UP u ME� HAMCAL PLAN M2 SCA 1/4"=1 —o No. /02d F. 1 e�, t A r1l) I�ellrlp) i -] FAN --3 From: 952 445 5119 Page: 1/3 Date: 2/29/200810:35:21 AM 'SSOCIATED mechanical contractors,'! n c. 1257 Marschall Road, P.O. Box 237 • Shakopee, MN 55379 Phone: 952/445-5100 Fax: 952/445-5119 Date: )-, 2 9 - o 3 Company: Attention: v1,F leN h f From: L C'e, Pages (including this page): PROJECT.,, Message or Comment: rid l d �►r_ �. .-� �� ��}' (Vote to facsimile operator: Please deliver this facsimile transmission to the above address, If you did not receive all of the pages In good condition, please advise sender at your earliest convenience, Thank You. Excelling in Design Build For Over 25 Years - 24 HOUR FMFRCTFNCY qFRVTCF - rn r VENTILATION TEST REPORT JOB NAME: DATE: AREA SERVED: Lynwood Healthcare 2128f2fl08 SYSTEM TAG: PAGE #1 HVAC 1 AREA SERVED # OF OPENINGS SIZE REQ. CFM PRELIMINARY PRELIMINARY FINAL CFM REMARKS RTU -1 Gym RTU -1 Therapy RTU -1 1 2 3 18x16 18x16 1140 500 800 694 2p 475 1010 Changed fan to high speed Changed fan to high speed RTU -1 4 RTU -1 5 - RTU -1 6 RTU -1 7 TOTAL 1600 1380 1610 1483 RTU -2 1 NIA RTU -2 2 RTU -2 3 RTU -2 4 RTU -2 5 - RTU -2 6 RTU -2 7 RTU -2 g RTU -2 g TOTAL 0 0 0 0 Exhaust Gym Bathroom 1 Broan 503 150 147 147 147 Exhaust Tub Room Fan#3 2 Broan HS130 110 105 105 105 Exhaust Tub Room Fan#2 3 Broan HS130 110 102 102 102 Exhaust Bathmorn Farr#1 4 Mercury 80 32 74 74 Cleaned Fan Exhaust 5 From: 952 445 5119 Pagev3/3 Date: 2/29/2008 10:35:22 AM Phone: 952/445.5100 mechanical contractors, inc. ORSAT TEST RECORD Fax- 952/445-5119 1457 Marschall Fid • Shakopee, MN 55379 ADDRESS T - APT _FLOOR CITY SUBURB OCCUPANT c: / t' e'r OWNER HEAT L055 DATE HTG. INST. D - d A_ -- SOLD BY 5Sd e_',i e-J� G INSTALLED BY Electrical Work By R c'rr t Gas Line By c TYPE OF HEAT GA F HW STEAM SPACE HTR, UNIT HTR. -OTHER GAS DESIGN AIR CONDITIONER MAKE MAKE Model _ 7'f�� J�/ - Model Serial Serial INPUT Tonnage 4L T4i Gas Meter # CONTROLS THERMOSTAT ! . 0n Heat Plua Valve _E{.. Limit Limif Setting Fan Setting Pilot Type `r . Pilot Make Pilot Model Pilot Timing L.W. Cut OfF Pressure' _ Percent Co, Input CFH _ Percent O, track Tamp. Percent CO Vont Size KIND OF LINER SIZE NONE t Belt Size h, Q , Regulator Filters Size- Number Chimney Location Insid® Outside 1(1' Chimney Construction _ , Smoke Bomb Wiring DrQh Test Tag Door Pressure Lighting Inst. Date Tasfed Company Testing c Name of Tester /�. From: 952 445 5119 Pa6e: 1/1 Date: 2/7/2008 9:34:27 AM Building MECHANICAL PermitN .. Inspections COMMERCIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY 1E eU B 763-502-497p7 FAX EFFECTIVE 1-I-02 DATE YOUR E-MAIL ADDRESS SITE ADDRESS 3'700 r j _IV THIS APPLICANT IS: CONTRACTOR PROPER'T'Y NAME; C> OWNTi U TENANT ADDRESS; s T g n /V� rCITY STATE IP 1-fW 2 PHONE: CELL; FAX: CONTRACTOR COMPANY NAME: krfociAj NOTE: SEPARATE CITY yy�� CONTACT PERSON: c c /11�o Ir h STATE BOND N J EXP DATE: LICENSES ARE REQUIRED AND HVOC.GAS ADDRESS / Zf� � "( moi' F�� rl 1 f CITY f d �fCi[� c STATE M�21P �1 %�% PHONE: q f2 ' / 41f -fl C70 CELL: FAX SUBMIT COPY OF BOND AND INSURANCE CITY GAS LICENSE # CITY HVAC LICENSE H EXP: PERMIT TYPE ❑ MULTI -FAMILY k'COMMERCIAL ❑ INSTITUTIONAL C3 CONDO ❑ INDUSTRIAL ❑ SWIMMING POOL ❑ OTHER TYPE OF WORK: ❑ NEW ❑ REPLACEMENT t (ALTERATION/REMODPI, DETAILED DESCRIPTION OF WORD: �L ti �r r tl �. --�-o � • d �� ro r+i 0 0 2- s EQUIPMENT INSTALLED MFG: MODEL; SIZE/BTU MFG; MODEL: SIZE/BTU MFO: MODEL: SIZE/BTU _ A/C UCT WORK ROOF TOP UNIT (RTU) BOILER _ FURNACOP REFRIGERAtION _—CLASS 1 HOOD _ GAS APPLIANCE STEAMIHOT WATER HEATER _CLASS it HOOD _GAS PIPINGSWIMMING POOL —COMMERCIAL KITCHEN _ POOL HEATER __- OTHER ALL FEES ARE BASF -D ON VALU TION, INCLUDING THE COST OF LA R AND MATERIALS: TOTAL ,TOB 'VALUATION: $ & k, � S/2 y 6 , + S f � � 7 ''/ S, q yo 9 PERMIT FEE $ `- 1.25°/o OF JOB VALUATION / MINCMUM FEE $_35.00 SURCHARGE $ `o. VALUATION -x,0005 / MINIMUM -5o TOTAL DUE $ MINIMUM $35.50. Make Checks Payable to: City of Fridley TI -IIS IS AN APPLICATION POR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a mechanical 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 on site; that the work will be in accordance with the approved pian in the case of all work which requires review and approval of plans. SIGNATURE OF APPLIC T I PRINT NAME Z 4 � /J> n l. -J -x / h DATE - 7" D j APPROVED B DAT City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 I N rru� axonx Fe`s oMF NT SCFILDULE — _— �..� c C b� i R ROOF 4N D M 1 Q I ti �I I m v/FCHANICFI P-AN h T� q�� �������� SV1E,1IF v \ 3v !as 3� mo $z zz ;a O � zZ ak' ^ ©' ©� �•., �,., ,,. d BEd �y7 zg&:§@a 7� ƒa£ 222 � // % 22 c= � 2 k\ Q � LL orC) m < 7 0 vqhe z � E y � < 2 00 ` o CD \\\! & ± � E � < \\\ k o \f\� w C K . > SSE R o000 /&® 7 ® » E nco f c C I I �ƒ�_N\\ 2 k ca § Im m O z Z ƒ_wn�no¥ �qn#oow@2 NmIqIn O ¢ w 0 � k 0 � U uj § LL F @ kLL / .. o 0 0 / k k k f ����-��© zm» 997999999 kkk\\ �o »/ @RebRRe o eeReR¥ew¥ mmq�■ O jo »n -j@ %2y2��� e Q� � \ 3v !as 3� mo $z zz ;a O � zZ ak' ^ ©' ©� �•., �,., ,,. d BEd �y7 zg&:§@a Jan,31, 2008 8:31AM ASSOCIATO MECHANICAL B�4N' MODELS 502 & 503 SIDE DISCHARGE FANS Efficient, high-performance ventilation for a variety of wall or ceiling Installations. FEATURES GRILLE: • Contemporary styled grille complements modern decor • White polymeric grilles can be painted to match any decor MOTOR: • Motor assembly offers fast, easy'lwistdock" installation • Permanently lubricated, thermally protected, plug-in motor • Specially designed fan blade stays in balance - will not distort HOUSING: • Installs easily in walls or ceiling • Steel housing 25 gage finished with rugged electrically - bonded epoxy paint • Built-in backdraft damper • FIIs 3'/a' x 10' duct • Adjustable mounling brackets span from 14" to 24" SPECIFICATIONS MODEL VOLTS1 AMPS JRPMJ SONES JCFM I DUCT 502 120 1.7 116MI 8.012701:3/-"x 10' 503 1 120 1 1.5 117251 5.0 1160 3'/ " x 10" No, 6821 P. 3 SPECIFICATION SHEET TYPICAL SPECIFICATION Ventilator shall be Broan Model 502 (Model 503). Ventilator shall have compact steel housing finished with electrically -bonded epoxy paint. Grille to be while polymeric. Motor assembly shall be removable and permanently lubricated. RPM shall not exceed 1600 (Model 502), 1725 (Mode! 503)_ Air delivery shall be no less than 270 CFM and sound levels no greater than 8.0 Sones (Model 502), (160 CEM and 5.0 Sones — Model 503). All air and sound ratings shall be certified by HVI. Units shall be U.L. listed. MODEL 502 MODEL 503 HOUSING HOUSING MODEL MODEL 502 503 HVI-2100 CERTIFIED RATINGS comply with GRILLE GRILLE new testing lechnalogles and procedures sol1 tI .- p,escnft by the Home venmlattng lnSlllule, HVI for o nSur-shelf products, as they are available tp gpngumera. Product performance Is ratedal 0.1 in.atatiapressure,basedonleslstonduGed • in AMCA's &late-of-lhe-art real laboratory. CERTIFIED Sones are a meaeure of humanly-parceived loudnes a, based on laboratorymeasurements. 13roan-NuTone LLC, 926 West State Street, Hartford, WI 53027 (1-800-637-1453) REFERENCE QTY. REMARKS Project Location Architect Contractor Submitted by bate SVM uou4I uuJL Chapter 1 Administration Page 1 of 1 • 1,,1 .4 This standard shall not apply to facilities where all of the following are met: (1) Only residential equipment is being used. (2) Fire extinguishers located in all kitchen areas in accordance with NFPA:...,1,0. Standard for Portable Fire Extinguishers. (3) Facility is not an assembly occupancy. (4) Subject to the approval of the authority having jurisdiction. EWED 09 http://www.nfpa.org/codesonline/document.asp?action=load&scope=l &path=NFPA/archivecodes... 1/28/2008 Annex A Explanatory Material Page 1 of 1 A.1.1.4 This judgment should take into account the type of cooking being performed, items being cooked, and the frequency of cooking operations. Examples of operations that might not require compliance with this standard include the following: (1) Day care centers warming bottles and lunches (2) Therapy cooking facilities in health care (3) Churches and meeting operations that are not cooking meals that produce grease -laden vapors (4) Employee break rooms where food is warmed http://www.nfpa.org/codesonline/document.asp?action=load&scope=l &path=NFPA/archivecodes... 1/28/2008 1Engineering WATER AND SEWER Permit No.: -763-572-3551 PERMIT APPLICATION Received ByA.&J__ 70-571-1287 fax CITY OF FRIDLEY D e'4'd�,ll(; 19 EFFECTIVE 6/9/09 APPLICTATION DATE: V YOUR E-MAIL ADDRESS: _ THIS APPLICANT IS: kOWNEER ❑ CONTRA TOR JOB ADDRESS: . 5 �OO — /= J C h K ed NEW CONSTRUCTION PERMIT# (IF APPLICABLE): PROPERTY NAME: L• J �- O it L O CCN a f u; •+ L OWNER/ ADDRESS: S i0 - - Q .`� ttiA0 CITY R D 1' 17 A`'v STATE • ZIP TENANT PHONE: CONTRACTOR NAME: SUBMIT A COPY OF DRESS:OG CITY &40'k"j 'A IG STATE�ZIPYOUR STATE LICENSE WITH ,r PHONE r7G9>3 ���. CELLPHONE: APPLICATION STATE LIC # 6 17- STATE BOND: EXP DATE: -O� 1. Narrative/written description: n /� 2. Please attach sketch showing curb line, utility line, building, etc. with distances. PERMIT TYPE ❑ SEWER CONNECTION PERMIT $50 ❑ WATER CONNECTION PERMIT $50 WATER LINE REPAIR $40 L149 ❑ SEWER LINE REPAIR $40 ❑ ADD STATE SURCHARGE $.50 ❑ SAC CHARGE @ $2000 = �{(7. �� CD OTHER CHARGES (IF APPLICABLE) PAY TO UTILITY BILLING NEW WATER METER COST — SEE UTILITY BILLING SPECIAL ASSESSMENTS — SEE FINANCE WATER TAP — SEE ENGINEERING NOTE: WATER METER REPAIR, INSP OR SHUT-OFF / WEEKENDS & HOLIDAYS $125/HOUR-BILLED THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a water or sewer (new connection or repair) 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. I understand this is not a permit but only an application for a pe ' and wprk is t to start without a permit. ff _ SIGNATURE OF APPLICANT NAME:115 S SNS �2 DATE: -�9 _PRINT APPROVED BY: DATE: U L D COPY GIVE O: UTILITY BILLING (only if new meter) ❑ PUBLIC WORKS ❑ ENGINEERING City of Fridley Engineering Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3551 FAX: 763-571-1287 N y \-. z Aild?ng BUILDING Permit No.. � Inspections COMMERCIAL/INDUSTRIAL Received By: 763-572-3604 $. C.�j .001 times the total job valuation 763-502-4977 CITY OF FRIDLEY Dat 09 FAX $ $2000 per SAC Unit (Plans to MWCC for determination) ?rosion Control EFFECTIVE 1-1-09 $450 Conservation Plan Review DATE /p —^ d /- O 9, YOUR E-MAIL ADDRESS SITE ADDRESS 6 7e_? d r a TENANT yte No. PROPERTY OWNER NAME: ADDRESS: CITY STATE ZIP Cotal Due $C1 r11' ..7 PHONE: ARCHITECT NAME: ADDRESS: CITY STATE ZIP CONTRACTOR NAME: O C ' * NOTE: CITY LICENSE REQUIRED 'Q ADDRESS: P'0' 1�px `aC7 `� CITY�STATE yCJLIP �Sl�-�`L COMMERCIAL, PHONE:t,(� �� FAX INDUSTRIAL AND _766— MULTI FAMILY PROPERTY TYPE ❑ TOWNHOUSE COMMERCIAL/INDUSTRIAL ❑ INSTITUTIONAL ❑ MULTI -FAMILY PERMIT TYPE ❑ ADDITION ❑ NEW CONSTRUCTION ❑ OTHER ❑ REMODEL ❑ ROOF ❑ SWIMMING POOL PLEASE SUBMIT: 1.4 SETS OF DRAWINGS 5. CONTRACTORS LICENSE OR 6. SPECIAL INSPECTION 2. SURVEY/SITE PLAN LICENSE APPLICATION SCHEDULE 3. LANDSCAPE PLANS 7. PERFORMANCE BOND 4. ENERGY CALCS AMOUNT $ BUILDING TO BE USED AS: OFFICE WHS SF OTHER SF _SF TOTAL SIZE: STORIES FIRE PROTECTION (Y/N)_ AC(Y/N DETAILED DE CRIPTION OF WORK _ �^ 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 f pe i d work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of k c uires rye and approval of plans. /' [ n SIGNATURE OF APPLICANT PRINT NAME �G ON (JCS sq) d- Y%ptDATE_ ALL FEES ARE BASED ON VALUATION Sq. ft. x $ Cost/sq. ft. = Valuation $ Sq. ft. x $ Cost/sq. ft. = Valuation $ Sq. ft. x $ Cost/sq. ft. = Valuation $ TOTAL JOB VALUATION: $ ;jQ USE OCCUPANCY TYPE 'ermit Fee $ j'7 See Back Page for Fee Schedule 31an Review $ — 65% of Building Permit Fee 'ire Surcharge $. C.�j .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 ;AC Charge $ $2000 per SAC Unit (Plans to MWCC for determination) ?rosion Control $ $450 Conservation Plan Review 'ark Fee $ Fee Determined by Engineering ;pecial Assessments $ Agreement necessary ( ) Non Necessary ( ) Cotal Due $C1 r11' ..7 Make checks payable to: City of Fridley Attach Stipulations Building $ L !`� . `'�> BUILDING Permit No.: ( �t -` Inspections 65% of Building Permit Fee COMMERCIAL/INDUSTRIAL Received By: 763-572-3604 Surcharge CITY OF FRIDLEY Dated: 763-502-4977 FAX $ $2100 per SAC Unit (Plans to MWCC for determination) Erosion Control $ EFFECTIVE 1-1-2010 Park Fee DATE �� `" - 61D 1 U YOUR E/-MAlk ADDRESS SITE ADDRESS TENANT Suite No. PROPERTY OWNER NAME: �Y ADDRESS: CITY STATE ZIP PHONE: ARCHITECT NAME: ADDRESS: CITY STATE ZIP 44 CONTRACTOR NAME: ®Ce y— *NOTE: CITY LICENSE REQUIRED ADDRESS: rr�� D CITY t 1 STATE !QIP COMMERCIAL, PHONE:—• c�O ,j� FAX INDUSTRIAL AND MULTI FAMILY PROPERTY TYPE ❑ TOWNHOUSE COMMERCIAL/INDUSTRIAL ❑ INSTITUTIONAL ❑ MULTI -FAMILY PERMIT TYPE ❑ ADDITION ❑ NEW CONSTRUCTION ❑ OTHER RREMODEL ❑ ROOF ❑ SWIMMING POOL PLEASE SUBMIT: 1.4 SET SETS OF DRAWINGS 5. CONTRACTORS OR LICENSE 8. 1 SET -DIGITAL OR ELECTRONIC 2. SURVEY/SITE PLAN LICENSE APPLICATION PLAN 3. LANDSCAPE PLANS 6. SPECIAL INSPECTION SCHEDULE 4. ENERGY CALCS 7. PERFORMANCE BOND AMOUNT $ BUILDING TO BE USED AS: OFFICE SF WHS sF OTHER SF TOTAL SIZE: STORIES r FI ROTECTION (Y/N) AC(Y/N) DETA D DES TI OF WORK -' 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 per i, and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case o wo c require view and approval OF APPLICAN 2oftans.SIGNATURE PRINT NAY� ATE/ ALI(,PEES ARE BASED ON VALUATION Sq. ft. x $ Cost/sq. ft. = Valuation $ Sq. ft. x $ Cost/sq. ft. = Valuation $ Sq. ft. x $ Cost/sq. ft. = Valuation $ TOTAL JOB VALUATION: $ /!;�?%� USE OCCUPANCY TYPE Permit Fee $ L !`� . `'�> See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ j, 1 .001 times the total job valuation Surcharge $ " .0005 x Permit Valuation Minimum $.50 SAC Charge $ $2100 per SAC Unit (Plans to MWCC for determination) Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Special Assessments $ Agreement necessary ( ) Non Necessary ( ) Total Due $ : ' -> Make checks payable to: Ci of Fridley Attach Sti ulations