AF - 36496sua�ecr PERMIT NO.
City of Fridley _ 15 3 7 9
AT THE TOP Of THE TWINS g U I L D I N G P E R M I T
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; � RECEIPT NO.�
� • COMMUNITY DEVELOPMFNT DIV. �� � 6 g
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r � � PROTECTIVE INSPECTION SEC. � � / /
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�l � /��'1 � CITY HALL FRIDLEY SS432 NUMBER REV OATE PAGE OF APPFOVED BV
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612-571-3450 g10-F15 g/7/79 � �
JOB ADDRESS 1633 Brenner Pass N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. L� 1 Innsbruck North. Townhouse Plat S SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Darrel A. Farr Development Corp. 7286 - 72nd Lane N., Brooklyn Park, MN 55428
3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO.
Same 560-8110
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Construct an 18' x 28' Townhouse (B Unit)
9 CHANGE OF USE FROM TO
STIPULATIONS party wall must be two separate 1 hour walls from bott�n to roof.
Firestop soffits. Provide combustion air for furnace frcen outside.
SEPERAT'E PERtitfTS REQUIR_ED FOR 1i�laft�,
ti�ATiNG, PLUMBiNG AN� SIGNS. WARNlNG
8efae di�1nE calt iocat utilities
tEIEPHON� - EIECTRIC - GAS Etc.
REQUIRED BY LA ��/
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCYLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOCl FYdIIlA
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 1332 11,952
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $23,560 Sl�-.7H
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF NY ER S OR LOCAL LAW REGULATING CON-
STRUCTION HE RFOR ' E OF CONSTRUCTION. y�4%.HZ $425.00
/ y� PLAN CHECKFEE TOTALFEE
� �-� � J` l C 11. 95 $496. 54
SIGNATUREOFCON ORAU R12EDnGEN7 IDATEI , HEN PROP ID ED THIS IS YOUR PERMIT
' � _ _ ` /� 7
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SIGNATURE OF OW NER IIF OWNER BUILDERi IDATEI BLDG iNSP qFT
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• ltP�'1.tCl�T101� COR lt�:SIll(=tdTl/1L �UJI_D1(•1G t'EIt1�iITS . �
' (�'��Vl, nLTE(t/1T1 Ut15, nl)llI710I1S, OR R�P/1l RS� �
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Addr.ess : � � .�!"1 • '���rr.f� �'��I�i.� I ���XCJJ : -
L. J��-'t-J� 7CCl.. I`:O .: c�o L� -�JI �J �
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LOT: � BLOCY.: % s ADDxT70t� : _S �
CORTJFR L�JT: X IIdSIllE LOT: S;:TT311CY.i Sxll1:Xl�R�S: '
T,p;��licai:t af.tach to L-his f:oxm 1�a� Ceri:ifi_cates oi Survey af_ I�ot� and pr.oposed
bui.lQi.ng �ocaL-ion drawn on these Certificates. .
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To 33^ U°ed As:
DESCRI PTI01'd OF $UI LDI I�G
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- �Gt.�c��_..._- � Txont i �� Depth : . a� ' liei_c�h � : a� �
- . Squ�re Feet;: ,j�33� Cubic �eet: �/95�
'I�con�: Depi:h: �� Neight: -
5qua�-e I'eet:� Ciibic Fee�: ' T
�ype o.i Constxuction: �/ a�-c�-� .,_. Estimated Cost: $ a O
�b Be Coinnlei:ed: %t-trv' % � � . , �Alt. A Alt_ B
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° Pxoposed Drive�oa�► t��idL-ii xf I�ew Opening Is Desired $ S
° � (S�T: 12�VERSE STDI: OF SF�E:ET)
Ti�e undcrsigned herei.�y tnakes application for a permit ior ihe ��ork I�erein �
specifi.ed, ar,reei�zg �o do a11 �cor}: in strict acc�rdance �•Ilt_�7 tlie Ci.t�� of _
Fx�dlcy 01-di»..nces and rulinqs of tlie De?,atL-:��e�1t of ruildiitgs, aiid licreby -
decl_ares th�t a�.l the facts and xepreseni:aL-ians stated in this applicatioTt
a�:e t-�ue :u�d corrcct. �See xeve�se siac tox' aclditio�ial xi�fo��lation.
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I���,:�ci f ��t„cee x S3.00
IU�����: P.,�ture G�,cn1n7 x $2.00
I�e� l'I,t,��a, Old Oper,f: , x $2.00
G►�,,h O�sln x i5.00
Hacei Ilu�[er -�0 9y,000 611J a $5.00
lUU,000 BIU [0 15 ��0 BTU x 510,00
Ue�ur 5,.lcennr x 57.00
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i:lec�il� N►te[ Ile�te[ x 55.00
nS I�I I fI�;G hl:ES�
lat 1 t�s�u�es z 53.OD
l�1,I��i�,r�t Flsturas x 51.00
l,�a I�.�i,.�n tJ 195,OUu bIU x 510.00
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�o�, �,�,�«�, 1633 Brenner Pass
Dc��arunr:nt c1' ��t.:.ili��y ^—_.
CiLy�Gt (�lili�i.Y • �
Tel., 11571-3•I50
7�I113 UIiCIGL'9l�ild.i I�,.:rcL•y r.;;kc� appllc:E::.� :;,r c-�r,cl� (,. �
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epe,elEled a;�r«1„� �� .70' al! wcrk in striet .:_cr.;�r.ca wiel. el,� City (:��.,:y
dnd rulln�s c� tl�a �e�:;;r�mcnc oE O�i:,�tr.�;, :,. •e:C�� „�,;larci tt,et nl l
tliu f�cLii n��d re��r„s„c[a�lona st�to,7 tr ch�e :.�,;,.;c�ticn «ro [��o nnd �;�.� r�,ci
' c•r:a1�y, :;,-.. 2-28–�0
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C{•INCR DA�?ELL FARR �
xruo oF uur�.ct�;.; ' frame ,
USED AS r'e5. �
TO DE COIIPLGTE:G t.L„UP 3-6-?�0
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. �.
SUBJEC7 .
City of Fridley _ 20269
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r �
; � RECE .
� • COMMUNITY DEVELOPMENT DIV.
� � V- - (}
r � � PROTECTIVE INSPECTION SEC. � � Q-)
� �
� � /���1 � CiTY HALL FfiIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
� ----�: `.� 3/28/90
612-571-3450 910-F15 / /
JOB ADDRESS 1633 Brenner Pass N.E.
1 LEGAL �OT N0. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 4& 11 1 Innsbruck North Townhouse Plat S SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Alan Srbech. 1633 Brenner Pass N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
D& P Builders Inc� 2370-3rd Street N.[�I., New Brighton, MN 55112 633-8375
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION C� REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Replace ro,tted siding on �ire�la.ce chase
9 CHANGEQFUSEFROM TO
STIPULATIONS
Call for ins�ection after tear-of�.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCv LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VO10 IF WOF;K 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 CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1' STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVEFNING THIS TVPE OF WORK WILL BE COMPLIED $1,476 $• 74
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GFANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITV TO VIO�ATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $3S.00
S RUCTION OR THE PERFOAMANCE O CONSTRUCTION
PLAN CHECK FEE TOTAL FEE
��._ � a� - yo $35. �4
SiGNA1UFlEOFCONTRACTOFlORAUTHOAIZEDAGEN7 IDATEI EN PRO E V LI A E THIS IS YOUR PERMIT
�-' _ �,,���
SiGNATUREOFOWNERUFOWNERBU�LDERi IDATEi BLDG iN$P qa E
N� [] CITY OF FRIDLEY Effective 1/1/90
�� [ � R-1 AND R-2
�T� [ ] Buildir�g P�ermit Application
o�nstruct.io� �aress: /63.3 ,� ��Q
Iegal Description: �'zx-P` �- %/ �,�c� � //J� T �. �-� s
Owner Name & Addres.s : _ ���� �.J�%U--�-� T�e1. �
O�ritractor: - l�r'-t� , �-c.�t.�=t�-�'LQ ��c� . Z1el . # LA3c3' - S,�'.3 7s -"
�aress: ��c:3 �C� 3/�,,(% --� � ���i i�� �3 ' �.� %�x, ss-���
� ,,
Attach to this application, a Certificate of S�rvey of the
lot, with the prq�oser3 �nstruction drawn on it to scale.
E�'r= «. ��Y r.� �. - �..�.:���`�r„i�.I
LIVII�Ir ARF�s Length Width Height Sq. Ft.
Q�R� ARF:�1: Length width Heic�t Sq. Ft.
DDCR ARi:A: Iergth Width Hgt/Grour�d Sq. Ft.
ORi�Ft: � , ��J
cornex Iat [ J Inside r�t �[ ] _ Ft. Yd setback Side Yara setb�acxs ��`�7� U�
�j�e of Construction: y7 ��� �t; g
Approx. CXa��letion Date:
Propo�ed Driveway Width If New Openir�g Is Desired: Ft. $ $
dth + 6' See BacJc Page
nA�: � � �' - �o �cArrr: ��—� � ,� �e1. # 6 3�3 - g�,3 �S,
P�ermit Fee $ ,�,5 , C�n
State S�lrrharge $ rf �
SAC ��ge $
Driveway ��crow $
Park Fee $
Sewer Main Ct�arge $
• v
STIPIJIATIONS :
S �� `1`
CITY USE �Y
Fee Schedule on Reverse Side
$.50/$1,000 Valuation
$600 per SAC Unit
Alt. "A" or Alt. "B" Ai�ove
Fee Determit�ed b'Y �J�r�4
Agr�nt Neoessaiy [ ] Not Neo�sary [ ]
�
�
3-a�'S�
:�� � . . • �•. � - :�- :.:�:�. �
The Chief Building Official shall, before ���+» *�+Q peanits for the erec�tioa� of any
build.ing or structure, or for ar�y addition to ar�y existirtig buildirig or structure, or
for ariy alteration or z�epair to ar�y existing build.irx3 or structure, �oti application
therefore, require the payment by the applicant for such pezmit of fees to the amaunt
herein belvw set forth and in the manner herein provided t,a�ait:
�VI'AL VAIIJE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
��
$15 (Minim�mm Fee is $15 plus surchat�ge)
$15 for first $500 plus $2 for each additional $100 or
fraction thereof, to ar�d ir�cluding $2, 000
$45 for first $2,CTt1a plus $9 for ea� additional $1,000
or fraction thereof, to ar�ci including $25,000
$252 for first $25,000 plus $6.50 for each additional $1,000
or fraction thereof, to and it�cludi.r�g $50,000
$414.50 for first $50,000 plus $4.50 for each additional
$1, 000 or fraction thereof, to ar�d it�cluding $100, 000
$639.50 for first $100,000 plus $3.50 for each additional
$1,000 or fraction thereof, to ar�d including $500,000
$500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additional
$1,000 or fraction thereof, to arXi including $1,000,000
$1,000,001 ar�d up $3539.50 for the first $1,000,000 plus $2 for each additional
$1,000 or fraction thereof
DdtIVEWAY D�PRESSI@I F5�f�7
(Concrete Cvrb Streets OnlY)
Alternate "A" : R�aval ar�d repla�.nt of curb and gutter only - Drive�ray width plus
6 feet t]me_s $13.50.
Alternate "B" : R�al aryd replac�nt of curb ar�d gutter ar�d install a 3 foot wide
approach with 6 i.rx�h depth - Drive�ray width plus 6 feet times $15.75.
� �• � v• •; • � i� • •;
P�ermits for construction will be issued a mininnun of 24 hau�s frran the time of
application to allvw for proper review of the proposed stYVCture arid of the
canstniction site.
A Certificate of Survey of the lot, shcxaing the location of the fau�dation once it has
it has bee.n oonstructed will be required before pra�eding with the framis�g.
_
_
CITY OF
FRIDLEY
FRIDLEY MUN[CIPAL CENTER • 6431 UNLVERSITY AVE. N.E. FR[DLEY, MN 55�32 •(612) 571-3450 • FAX (612) 571-1287
June 12, 1991
Mr. Al1an Srbich
1633 Brenner Pass NE
Fridley, MN 55432
Re: Chimney Chase Repairs
Dear Mr. Srbich:
As you may recall, your chimney chase was repaired during the month
of March, 1990. At the time your chimney was repaired, the
interpretation of the number of fire stops required was for only
one to be located at the first floor level above the fireplace.
Therefore, please be advised that your chimney chase does meet the
Building Code as repaired.
Sincerely,
U i,� �-Q/'t v
DARREL G. CLARK
Chief Building Official
DGC/mh
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SuB�ECT .
c�ty of Fridley 3 0
AT THE TOP OF THE TWINS g � I L D I N G P E R M i T
r
; � RECEIPT NO.
� `y _�_�� COMMUNITV OEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. �Q��
� � �"'1 � CITY NALL fRIDLE� SS�J2 NUMBER pEV O�TE v�GE Oi APVqpvEO Br
�----�•� �•' 612-571-3450 910-F15 6/27/00 � �
108 ADDRESS 1633,35,37,39,41,43 Brenner Pass
t LEGAL LOT NO. BLOCK TRACT OR AOOITION SEE ATTACHED
DESCR. —( � 7-12 1 Innsbruck North Townhouse Plat S SHEET
2 PROPERTV OWNEA MAIL AODRESS IIP PHONE
Innsbruck Townhome Association 651-224-5482
3 CONTRACTOR MAIL ADDRESS ZIP PMONE LICENSE NO
Garlock-French Roofing corp, 2301 E. 25th St., Mpls., MN 55406 612-722-7129 0000142
a ARCHITECT OR DESIGNER MAIL AOORESS ZIP PHONE IICENSE NO
5 ENGINEER MAII AODfiESS 21P PMONE IICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION �1 REPAIR � MOVE O REMOVE
B OESCRIBE WORK
Reroof Townhouse Building (Tear off)
9 CHANGE OF USE FROM TO
STIPUTATIONS
i3nderlayment must comply with the State Building Code.
Permit Inspection Cards
Will Be Mailed
To Homeowner To Post
TVPEOFCONST OCCUPANCYGROUP OCCUPANCvLOAD
SEPARATE PERMITS ARE REOUIREO FOR EIECTRICAL, PIUMBING. MEATING,
VENTI�ATING OR AIR CONOITIONING
THIS PERMIT BECOMES NULL ANO VOIO IF WORK OR CONSTRUCTION ZONING SO. f7 CU FT
AUTHOR�ZED IS NOT COMMENCED WITHIN 60 DAYS. OF IF CONS7RUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 1�0 OAYS AT
ANV TIME AFTER WORK IS COMMENCEO NO DWIG. UNITS OFFSTREET PARKING
I HEREBV CEATIfV THAT I HAVE READ ANO EXAMINEO THIS APPLICATION 6 STALLS GARAGES
ANO KNOW THE SAME TO BE TRUE AND CORRECT ALl PROVISIONS Of LAWS yq�UATION SURTAX
AND ORDINANGES GOVEFNING THIS TVPE OF WORK WILL BE COMPLIED �21 194.%S �IO.S9
WITN WHETMEfi SPECIFIED MEREIN OR NOT. TME GRANTING OF A PERMIT �
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL THE pEqMIT FEE SAC CHARGE
PROVISIONS O� ANY OTHER STATE OR LOCAL LAW REGULATING coN. �349. ZS Fire SC �21. I9
STRUCTION Oi7 TME PERFORMANCE Of CONSTRUCTION
PLAN CHECK fEE TOTA� F
$38 . 3
S�GN�TUAE OF CON'AACTO�7 OQ AUTMOQ�ZEO AGENT iD�TE� EN ROP ALIDAT 0 �S IS V UF PEQMIT y
�•IV —V V
S�GNaiUQE O� OwNEQ��� OwrvEp Bu�tDEQ� iO�TE� C�, p} uv5o r�r.tF
� �� �.��
�-
N� � � . _ Effective 1h/2000
ADDN [] CITY OF FRIDLEY 612-6T2-3604 Bidg Insp
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMITAPPLICATION -
' '1 �?-.�1 �I ( �-l3 7�� i'�� I`'G1s5 : . . . . _ . .
Construction Address: 1 �' .3� ,_� � � � , � , -
Legal Description:
Owner Name & Address:
Contractor: � G C-
Address: a3D I �S
LNING AREA:
��,+���.# �s� -a�y - 5���
MN LICENSE # ��D I � a3
>Syo�Tei. # � l�- ��a-�l� �
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
GARAGE AREA: Length
DECK AREA:
OTHER:
Width Height Sq. Ft
Length Width Hgt/Ground Sq. Ft.
Construction Type: �0 � ln Estimated Cost: $ � 1 � � � � • � s -
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: l� � APPLICANT: u� �� ���t'1 Tel. # r, � a-� a a-� � a�
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (612) 572-3604 for Permit Fees if mailing in application
$ 9�as Fee Schedule on Reverse Side
$ �/• /9 .001 of Permit Valuation (1/10th%)
$ /�� - S9' $.50/$1,000 Valuation
$ � $1100 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 [ J Not Necessary [] _
$ r� `�� � � C��
�:1 u
, �;�t
.�< . ,
� a
��� �
�
.. .. . .
BUII,DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alteration or 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 tawit: �. .
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23 .50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete C�rb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Pernuts for construction will be issued a minimum of 24 hours from the time of applicadon to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the locadon of the foundation once it has it has been coastructed will
be required before proceeding with the framing. New Houses Onlv
CITY OF FRIDLEY BUILDING INSPECTION
6431 University Ave NE
Fridiey, 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
1-��r Effective 4/1/2004
��
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Fee Total
$35.00 $��
$10.00 $
$10.00 $
$10.00 $
$25.00 $� �
All Other Repairs or Alterations (List on Back) �
1°/o of Value of Appliance or Work
Minimum Fee $15.00 for Residential or 5% of cost of
Improvement whichever is greater on work less than $500.00
Commercial/Industrialf Institutional
1.25% of Value of Appliance or Work (List on Back)
Minimum Fee $35.00 for Commercial/Industrial/Institutional
State Surcharge
TOTAL FEE
REINSPECTION FEE $50.00/HOUR �
$
$
$ .50
$ i7 • �
*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
JOB ADDRESS � 1O �� �Y�' v���. ��S S
owner���nt� S%Z%J1L�
Building Used
U
ESTIMATED COST S, Gc�c� <� PERMIT NO
DESCRIPTION OF FURNACE AND BURNER
# of Heating Unit � Circle One (Steam) (Hot Water) (Warm Air)
Trade Name �Lu- � Size No.
BTU C�� � HP EDR
Fuel �- � Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
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.
HEATING CO ( � C't (�°l;�"'� � � �'�
Signed � � r- Tel # � ��' l2�
FAX #�O� �— �O�-O `G f 2-�� Date 1G /r 3 �O i
Approved by Rough-in Date Final Date
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacina an existinq 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-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances.
The existinq combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
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 ( )
Yes ( ) No ( )
Yes ( ) No ( )
When installinq a new ventina svstem, 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 ()
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.
No ( )
Yes ( ) No ( )
Appliance Tvpe and Size/Common Vent and Vent Connector Information
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 Tatal 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
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date :
i ADDRESS
' PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
��►���Zi� �► �.�
: 1633 BRENNER PASS NE
: 243024440121
: INNSBRUCK NO T H PLAT 5
: LOT 4 BLOCK 1
: HEATING
: RESIDENTIAL
: ADDITION/ALTERATION
5"/ 1-ll2f"/
-- . �
PERMIT Nd.: 2004-01870 •
DATE ISSUED: 10/13/2004
VALUATION .
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
INSTALL A FURNACE (WARM AIR, AMERICAN STANDARD, 80,000 BTUS) AND AN AIR CONDITIONER.
# A/C iJNITS 1 # FURNACES 1
# GAS DRYERS 0 # GAS RANGES 0
VALUE (FOR MINIMUM CALC) 5000
APPLICANT
G & H HEATING & AIR
1101 2 STNW
NEW BRIGHTON, MN 55112
OWNER
SRBICH ALAN G& DEBORAH A
456 83RD LN NW
COON RAPIDS, MN 55433
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wor�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisio s of any other state or local law
regulating construction or th perfo ance of construction.
Applicant Date��
Bldg
HEATING PERMIT MINIMUM FEE
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIONING FEE
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 5559
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
0.00
35.00
0.00
0.00
25.00
0.50
60.50
n
rrom: �.iry or rrtaiey io: o� it�o iun4 rage: o3 uate: a«3rtu i� i: i i:3t rnri
Buildirlg BUILDING Permit No_: � t� i' �(. C'
Inspections RESIDENTIAL APPLICATI�N Received By: � `
763-572-3604 �ITY OF FRIDLEY � D ��� 2�. �n�n
763-502-4977 FAX �� `
EFFEGTIVE ;-1-2010 I
DATE YOUR E-MAIL ADDRESS
STTE,�ti�SS ���./��/ 3�. /� �/�s�1�-/'� y3_
THIS APPLICANT IS: ❑ OWNER �iGONTRACTOR
PROPERTY OWNER/ I NAME:
TENANT �DRESS: CITY_ STATE
COt�TTRACTOR
SUBMIT A COPY OF
I'OL-R STAT'E LICENSE
AND CERTIF1Ct�TE OF
INSUR.ANCE
PROPERTY T�'PE
PERMIT TYPE
TYPE OF WORK:
DESCRIBE i�JORK BEING
SIZF OF IMPROVEMEN
I ROOFIYG
i NUhiBER OF SQU.4RES
i G.�RAGES
� PRc7POSED SIZE:
I PROPGSED HEIGHT:
� S�i�irryl
❑ ,4lumir�um
Q Other
2vAME:_(�/�_�
STATE LICENSE
�D�SS: 9�,
PHONE (r���� a[S(o*-/O6�
❑ SINGLE FAMILY/NEW CONSTRliCT70N
❑ TWO FAMILY/NEW CONSTRUCTION
� ADDTI'ION ❑ GARAGFdSHED
❑ BASEMIII�I"P FIN[SH _ d jtGOF
S
❑ DECK �ISIDING
�� SWIMNIING POGL
❑ NEW HOME CONSTRUCTION ❑ ADDPI'
❑ MAINTENANCF/REPAIK . "6L�REMOI
��ZNDOWS
IN E;dSTING OPE:VINGS �Yes QNo
QR FOR NEW OPFNINGS-DESCRIBE SIZE OF
OPF,NING CHANGES &
�rvnF nF zuil.rnr�:�; Tn uF n.rcTnr T Fn
LENGTH
❑ HOLSE ONLY
❑ HOUSE & GARAGE
❑ ATTACF�D GAR�.GE
❑ DETACHED GARAGE
_ ffit
�m
ascia.
LOCA ION OF WIIv'DOWS
� —
NVMBER OF
,�
.�
�,.
— EXP DATE - 3 / �'
CITY _ �
FAX
SIZE
STORIES
❑ WINDOWS
❑ DRAIN TII.E
❑ OTHER
G
� .
N HEIGHT
__Z1P
��
ATF��IP� �
FT
BASEMENT REMODELING SUBMIT:
1. Existing Floa Plan
2. Proposed floorplan
3. List of strucwral members to be used
FOR NE�� CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SLBMIT:
1. Site Plan/Survey showing the e�dsting structures
and proposed projed.
2. Two sets of construction plans
3. Energy Calculatians
FOR WIlYDOW3 - PROVIDE U-VALLTE AND
LtA1VTJFACT[JRE STICKER ON LVINDQW.
ALL FEES ARE BASED ON VALUATIOiY, INCLUDIlVG THE COST OF LABOR AND MATERIALS:
S1NG THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALtiATION $� �� 3p� �`l7 °� OCCUPA1vCY TYPE
Permit Fee $ >>>.L �(;, �� See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
Fire Surcharge $ �`� �'� �,,' _ .001 times the total job valuation
Surcharge $ `�'� (,J,� .0005 x Permit Valuation Minunum $5_00
License Surcharga � 4;; �� $5.� (State Licensed Residential Contractors)
SAC Charge $ $2100 per SAC Unit (Plans to M�Z'CC for determination}
Gurb Cut Escrow $ ft+ 6 ft= ft x$24 °$
Erosion Control $ $45U Conservation Plan Review
IPark Fee $ Fee Dete�ined by Engineering
Sewer i�lain C}iarge $ Agreement necessary (} Non Necessary ()
, Total Due _ $ �:�;1..._��(' Make checks payabte to: CitF of Fridley Attach
I hereby apply�
conformance vr�i
permit but only�
approved plan �
SIGNATURE OF
APPROVAL INSPE
PLEASB
�'' HIS IS AN APPLICATION FOR A PERl�fIT-NOT VALID U?�TI'IL PROCESSED
for a building permit d I acknowledge that the mformation above is coFnplete and accurate; that the work will be in
th the ordinances o the City of Fridley and with the Mimzesota Construction Codes; that I understand tl�is is not a
an applicatio or a pe ��rk is not to start without a permit on site; that the work will be in accordance with the
ui e case o requ� es rev' and approval of � �{
f�
APP ^nANT TTmr PR1NT N _ DATE ��_�V
: S�SP
AR� REQL'IRED FC�R PI;�IIvIBIN
A�D:MEC;�IANIGAL:wORI� : :_. `. : '