AF - 34946SUBJECT P . .
City of Fridley 2 6 3 9 2
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
�
; � RE O.
� i v�_����� COMMUNITY OEVELOPMENT DIV. /
r � � PROTECTIVE INSPECTION SEC. � �/_ �
� � � :"J O
� j ����1 � CITY HALL FRIDLE� �43Z NUMBEN REV OATE PA6E OF APPROVED B�
�----� • •,, 612—s7 t-3450 s� aF� s 6 29 / /
J08 ADDI;ESS 5368 Altura g(�
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 27 6 Ca.rlso t SNEET
2 PROPERTY OWNER MAIL ADDRES$ ZIP PFIONE
Marxen� �3f� � 5 -
3 CONTRACTOR MAIL AODREB a � PHONE LICENSE NO.
Viking Home Im rovement 4832 -
4 ARCHITECT OR DESIGNER MAIL ADDRE88 ZIP PMONE LICENSE NO.
5 ENGINEER MAIIADDRESS ZIP PMONE LICENSENO.
B USE OF BUILDIN(i
Residential
7 CLASS OF WORK
� NEW � ADDITION � ALTERATION � REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WOAK '
Tear off and reroof and sidin re air
9 CHANtiE OF USE FROM TO
STIPULATIONS
Underlayment must comply with State Building Code
Install building wrap and call for inspection before covering
TYPE OF CONST. OCCUPANCY f3ROUP OCCUPANCV LOAO
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PIUMBINCi, HEATIN(i,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION 20NINd SO. fT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOO OF 120 pAYS AT
ANY TIME AFTER WORK IS COMMENCEO. NO. O1NLd. UNITS OFFSTF;EET PARKING
I HEREBY CERTIfY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION 1� STALLS GARAGES
AND KNOW TFIE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE Of WOFiK WILI BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING Of A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE p p T S RGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- Q87 � 25 Fire SC �3.67
STR ION R THE PERFORMANCE OF CONSTRUCTION. �i�
PLAN CNECK FEE TOT EE
- ��Z�s''!�� License $5.00 $ .75
SIGNATURE CONTFACTORORAUTMORIZEDAGENT IDATEI P OPE LIDAT HIS IS YOUR PER
�" r
SiGNATUREOFOWNER�iiOWNEtiBU�LOEtii 10A7E� �.,,<� L �NSp 0 E
N� � � Effective 1I1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [] SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2 Gl�` ��
� BUII,DING PERMIT APPLICATION ��J Mn
`� ',J
constructionAddress: S�3 (� �' �G�u r2 � R t� • � �
Legal Description:
Owner Name & Address: � 1¢ � /1�1 f�� a(,� � Tel. # .�� ��.�� �
Contractor: l/ rtc t..��. ffd•K� 2�.xP�ea.e e� � MN LICENSE #�% '7°7 Z
Address: �i 83 ,2 � �. v r ,� . � Tel. # .s°7�. — � 8'z t
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECB AREA: Length Width ` Hgt/Ground 5q. Ft.
OTHER: V
a�� - �P� �1��4
Construction Type: /��. Q a p� s� �,�-�� �- Estimated Cost: �S'��U o o�
�
�
� .i
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ °
DATE: 612 S�S� APPLICANT: ���� Tel. #�z�/�2 /
.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
. STIPULATIONS:
$ o� � �"
$ � jo
$ s
$
$ ��a
$
$
$
$
�
$ , �
CITY USE ONLY
Fee 5chedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,�0 Valuation
$10� per SAC Unit
$5. � (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.� Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
.��< �- �
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official sriall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,�
FEE5
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $5� plus $2.75 for each additional $100 or
fraction thereof, to a�d including $2,�
$2,001 to $25,000 $62.25 for first $2,0�0 plus $12.50 for each additional $1,000
or fraction thereof, t� and including $25,000
. }
$25,001 to $50,000
$50,001 to $100,�
$100,001 to $500,000
$500,001 to $1,000,000
$349.75 for first $25�(�0 plus $9.00 for each additional$1,000
or fraction thereof, t� and including $50,�0
$574.75 for °first $SO,Q00 plus $6.25 for each additional
$1,000 or fraction the�eof, to and including $100,�0
$887.25 for first $1�,000 plus $5.(� for each additional
$1,000 or fraction thPreof, to and including $5(�,000
r
$2887.25 for the first! $500,000 plus $4.25 for each additional
$1,000 or fraction th�reof, to and including $1,�0,000
$1,�0,001 and up $5012:25 for the fir.t $1,�,� plus $2.75 for each additional
. $1, 000 or fraction t�i�reof
�
Alternate 4 "A" :
A1tCTII1tC "B" :
DRIVEWAY DEPRF�iSION ESCROW �
(Concrete Curb �reets Only) '
�
�
Removal and replacement of curb and gu� r only - Driveway width plus 6 feet times $13.SQ.
Removal and replacement of curb and g� r and install a 3 foot wide
approach with 6 inch depth - Driveway , idth plus 6 feet times $15.75.
�
VERIFICATION OF FOUNDATION
Pernuts for construction will be issued a minimum of 24 hours from the time of application to a11ow for proper
review of the proposed structure and of the construction site. . �
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
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CHIlVIlVEY AND STACB VERI�ZCATION
The undersigned hereby verifies that the �existing chimney or scack:
1. . Has been c�refuily examined � � Yes () No i)
2. Is free from rust or deterioration � Yes ()� No ()
3e
4.
Iias no foreign objects lodged with�n
Is securely supported
5. Meets all current Code requirements for size
and total BTU's connected
6 Has total heating BT[T's of
7.
E�
All other BTU's
TOT�I, BTU's
Has a liner been provideci:for water heater .
Has combustion air been provided for water heater
Remarks: .
Yes( ) No ( )
Yes()No()
Yes()No() .
YesONoO.
Yes.()Na()
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� BLAINE HTC�. AiC EI�ECT.� QVC.
3� C AYE. W.E.
MN 553R4 �
I3EATING CO: � � �
Signed B�y: .
Date: _ --1 � $ � d1 �
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THE BELOW MUST BE FILLED IN WHEN REP�-p►CING FUEL BURNiNG APPLIANCES OR THE
APPLICATION Wil-i- BE RETURNED
•- �►. •,�: r•► � : � : � r•►
�•„��•� � � � ►r •�► - -
�� • , the undersigned.hereby verifies that the
ven�ng has been examined and is free from rust, deterioration, obstructions, Y�S �R.� No ()
and is securely supported arid firestopped where required.
The venting system is plastic/PVC and meets all current codes and manufacturer Yes (xl No ()
speafications including sizing, length, number o� elbows and termination.
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current c.odes � d�ma�n�ufF m� Ven� 9�ables fo' fanoes
. �-- - — - -- - . - - -�s� l- Na�( �
�ssisted and natural draft appliances.
The is sized and installed to meet the current codes
and manufacturer's specifications.
When r�quired to '' will be si�ed and installed
to meet the current c�des and manufacturer's spe 'cifications.
Yes � > No ( )
Yes � ) No ( )
� , the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
spedfica�ons. This does include AGA-GAMA Category I Cenbal Fumace Yes {� ) No ()
Ver�ting Tabies for fan assisted and natural draft appliances.
Is the common vent and vent connectors sized and instailed correctly after
an appliance has been removed from the common vent and vented Yes (g) No ()
separately as per current codes.
- � • � 1 ' N • � • /11 . 1 • 1
• � , � /���l�T�le1�IU1�1�n�iiii:i:��. - - - - -
Appliance #1 Type BTU Input Fan Assisted or Nat
_ ance#2� BTU Input,__ F�,�iSt�ed�.�fN�__ -- —
qppii�nce #3 Type - —BT�finput`--
Total Appliances _ Total Btu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 Verrt Connector Height _ ft Length _.____ ft Diameter _____:�n TYpe ._--
qppqance #2 Vent Connector Height ,_ ft Length , ft Diameter _in Type , �
Appliance #3 Vent Connector Height „= Length ft Diameter _�n TYpe
� r�: , r • ► �,- � ��=
,CenterPoint Ene �Bee 13562 Central Ave NE, An.oka, MN 55304
HEATING CO' rg� Mi n�+ a
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