AF - 36498��
sus�ecT PERMIT NO.
City of Fridley _ 15 3 7 8
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � COMMUNITY DEVELOPMENT D�V. R�� 6��
.
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r � � PROTECTIVE INSPECTION SEC. � � /
� fs
' ��/'���1` � CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPqOVED BV
� "'""�� �� 612-571-3450 910-F15 8/7/79 � �
JOB ADDRESS 1635 Brenner Pass N. E.
t LEGAL LOT NO. BIOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 3 1 Innsbruck North Townhouse Plat S SHEET
2 PROPERTY OWNER MAIL AODRESS ZIP PHONE
Darrel A. Farr Development Corp. 7286 - 72nd Lane North, Brooklyn Park, MN 5542
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Same 560-8110
4 ARCHITECT OR DESIGNEF MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Residential
7 CLASSOFWORK
❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
n 1' x 2' Tawnhou A Unit
9 CHANGE OF USE FROM TO
STIPULATIONS party wall must be two separate 1 hour walls from bottom to roof.
Firestop soffits. Provide combustion air for furnace from outside.
SEPEN�TE �ERMITS RE�QIitREd FOR Y�IRt�iG.
HEA'�INO. PWM8tN6 ANQ SIGNS. WAR��G
�e�0� /�EMt t�N loc�� utilities
TElFPMOME • EIFCTRIC • GAS Ete.
��QUIRED BY tAVy
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCYLOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIF 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 PERtOD OF 120 DAYS AT ].L� 12
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 SUFTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 14.OS
DOES NOT PRESUME TO GJ,�E AUTHORITY TO VIOLATE OR CANCEL THE p RMI FEE SAC CHARGE
PROVISION F A OT STATE OR LOCAL LAW AEGULATING CON-
STRUCTIO R E P F MANCE OF CONSTRUCTION. L�S 425.00
�` PLAN CHECK FEE TOTAL FEE
% �.u. `- „� r'
SiGNnruaE FCO �anCTOa auTHOaizEDaceNr IDATEI WHEN PR Y LI TED THIS IS YOUR PERMIT
' ' � O O ��
SIGNATURE OF OWNER�If OWNER BUiLDERi �DATE� B��G i!v5P ��FT
�'
. •
CI'fY 01= (=1tIl)I_CY . .
hPf'�tCl�iIU11 COft IZI�S11)f:t•1T1/1L �U)!_DI I•tG t'Cl2f�iIT y
(�'�L"Vt, nL1'Lft/1Tl Uld5, nl)1)IT10JJ:;, OR R,L'1'A? RS)
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r.or. : � }3LOCY.: % .-ADDx�r. xor� : � � . . ' _ .
COI21ItiR L�JT: t� XI1SxD� LOT: S: TPACY.c . Sxlll.Y11RDS: `
T�l�a�licart attach ia this form ��•�o Certi.f�.catc . of Survey af_ 7�ot znd P�:oposcd � _ .
bui_].c�ir►g �.oca::ian drawn on these Certifi.cates. . �
� . � . � . , _ -
. DESCRT PTI OFJ OF BUI LDI 1�G • �: ��,vju-� _'-
. � . �_ . . _ .
xo J3� Used �s: � � � ° , - � . -
_ . - . . _ . . .. ;... . - . - - . _ _ . . _.
• � _yi��.LQ�...—. Fxonti / � Uepth ' a t� ' � I�e�.ght: o� � _ ' • `
� . � . Squar_e �'eet: /5/0'� _ Cubic .Feet: . /�//�, . . . _ .
- 'Txont: Depth: � l3eight: . - - . -
. Squar.e Feet:' ' Cubic I'eet: -
� �'yp� oi Construction: ��-�-,� �tt�rrc�_._. �Gtirnated Cos�: $ �� /,�D .
• - ; � . - �
'� IIe Coi;�o].eted: �'7 i ' - � A1i._ 11 Al.t_ B
;
' Pxop�sed Driveway t•;idt}i 7f. Ne�•r O�ening Is Desi.red .� $ �
� ' (S�E 12�VEF•SE SIDE Ur SIii:ET)
Tize undersic��ied he_-eLy maT:�s appZication for a pe, nii.t for Lhe taorJ: lierein �
specif�.cd, �zr,rceing to do all �,ox}; in strict acc��_dance ��zt3i the Ci.t�• oF _
Fx�.dlcy Ordinanccs and rula�ic�s o� the beaa�Laict�L o� ru.ildings� z�3d iiezeby -
dec).a�es tt���t a�.l ihe �acts and rep�:eseni:aL-ian � stated in this applic�Cion
az_e L-rue �-u�id correct-. See zeve�se side tor acldiL-ional a.nio�ztaL-ion. _
• �� -
D�`ii.: �I � � -�cl SXGi�?1�'.t`Ul:i;: �
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0
$tlk�111.11:1 011 S : , �--� -
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HOUSE HEATING TEST RECORD
ADDRESS � ���QQ APT. F�00 ITY I BURB
OCCUPANT OWNER -« a
HEAT LO55 � ATE HTG INST/.�
SOLD BY �'" � C.�� • INSTALLED BY ��--
Electrical Work y °^" Gas Line By ����
TYPE OF HEAT GA FA JC STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION
MAKE �/���!1 MAKE OF BURNER
Model (,,,f ��.�/S.a,� Modsl
Serial Max. BTU Rating
INPUT � n MAKE OF FURNACE
Model
CONTROLS a
THERMOSTAT Heat Plug � D� Vent Size �
Volve KIND OF LINER—�'1- SIZE NONE —
Limit — Draft Hood �-v� Regula�or
Limit Setting �� Filtsrs $ize °N�umber
Fan Setting Ql! Chimney Location (nsids Il Outside
Pilot Type Chimnsy Construction
Pilot Make � .
Pilot Model l� Smoke Bomb W����9 ��
Pilot Timing - ' Draft t^�� Test Tay �-
L.W. Cut Off Door Pressuro Lightiny Inst. ��
Pressure ��' �j Percent CO2 —�-- Date Tssted
Input CFH %�� Peresnt OZ Company Testi�g
Stack Temp. ��r� Percent CO Name of Tsstsr
Form 235
, .� � ;;. a ,
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L'1 tY UF �HIULrY.
,�iPPL.ICATION roR PoWr'Ft f'L.nNrS AN1� IIEATING, COOLING, VC-NTILA7ION, REFRIGERATION AND
�lft CONDITIONING SYSTGh1S �ND DEVIC[:S
��RTin� ►�,r�T�� sc�iE n���_i_
��t,�vz'cY ti�:�!;�t nt r;: .;n•rr: •r���rn�.
1�1i�rri::„ ,�.���1] 1. f:�: �t �;;�rk, 'vl: .nf) C�
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ki�p.l3c��::�, r:�:. of t�'ti� :� ,c,. 7. u:l � —
iiet aiz�� .. :.it�:,�t_i��:�..-cp to ,.';OO.CO 7.00 $—
i �:p,�: cs L Ai;_�•r:�c ir�:.,, ,.ich .1 i l. ��„'!0.00 4.00 $-
�1c:Cii:1\IC,1L ,ti:\I�•1 :'�Ift:
F1zrn°j�e ., :i'_1 & C,u^:. t,��rk t� 1C0,000 P.TU ���17.00 $
0
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5�';.a�s ��!z it,,: �,. ; ,� ;t_,.
Fi�>i J c. t. ...,. . i:, ��!,lt�, OCO :�TU i1:..00
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. (.':L�t: :1C�:.i. 3 �"j.11. ( 1"" �':Jl::" • • IQ.Q��
G:l`.i '31;i2:,f_.. fr�-,:� ]c` i„i' i,:., t� 1'?��,�^� T3'}'.1 :1��.��
(�r:�r l'>^, ?`�9 .s•,',� ,:<,,• I'rir : �,t�����ial�:)
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. 1.:._'.i�.+:.al _'ir.turr� .. 1.GQ
t
G,a�� ;�J:.�c� .�) 1�'�,C�U &+L .. $�Ll-�Q
AiK CO\DITIU\I`:G✓ �I �'�hhOX /-�.fci-�IGI
F.a\ HE:1 CI `:G SY' �"1'(:'�!S 1 �ce Fec schedule
1'...�i I1,�1T1'�t� SYSfi:;�5 �
AL�I'f'.k.�;"I�IGV� � �j f'I:P,1I RS �
�r.it �. �urcti;irqn
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FT:tZL It:S?. �- �i',�f�
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A^?FJVAT. FOR PF.?,:;; J�✓`�"�
$
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N.2.`:LS;�:C Fc:c, F�R A::f !:1J,TL";� i':'P:1ZT I; $7. �0 PL'uS $.50 STATE SURCFi11RGE
'Attac.`.ci stack verifics�ioz for.a •
.. .��_ ,.��
Dc� artment of llu�lclin�a
Clty of Fridley
Tcl. 1�571-3450
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_ne undersigaed hereby ma;ces ��plication for a penr.it for the wozk herein
specified aqseeir.g to do all ��ork i.. _�_i:t accor�ance with the City Codes
and ruling� cf tl:e D�p�r;rient o` E•,:ildi:�:;s, ,»d i:cro,y decla:es that ali the
facts aiid repre�entations stated i� thi� application are t:ue and cozrect.
rzidlcY, ;4i.r,n. ��-�� , 19��}
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0',�:�I:lt ---�rV�/'L�i�L ��ti��_� �
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KI11D OF IIUILDING _ _ _
j1SI:P I� ��
�p #�� For;rL��cFq t,°opT /— ! � - �' /
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PFn - Fi1�W i�UT�.nrv� #�}'F��t��' r��>. ^_�_ + �':�;�, ,;o. 80'jS, ____
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DESCi!TI"PIC7a V:' Pl1I�':i+:.:L'/Ei'f.`:::R
#i�Tlr?G az �ow�R R�,HTs{ Ste�_�;, t;o� c-;ater, w,�r:� �i�- No.
T:ade Name _ s:ze �:o.
Capacity r
Total Contlecteci I.o�i:i
;q. 1't. E�R ------ LTU _ HP
IIUFNER - Trade Namc
C3p�city __ Sq. Ft, i,DR
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Y,ir.Q of Fucl
S+'_ze No.
13:J HP
Company
S i�� n c d F) �' -�i-1.�:�.sscf�c----���-
Tel. t�o. � � u ��,
�._ . . ...�. �..i�\ _. �� ,...� i/ r t l�'l� ✓i�.ViY4 .. _.
_: :� � X � �'�! m A �OV F . S �' ',.; I !--�
,:•. s�,i r_ ��.� O i._ I S; !��i l�i �541 �-�'
' r45-��51 __
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63-�1�-l�16051
CITY OF FRIDLEY
� aPPLICATIO�I FOR PLi7i BING AND uAS FITiI�VG PERMIT
z.:-
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^ '•� .i X C C 3 O U-± O.0 U U
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I.
�-�-� r e
I �ad � �
1�=� �' I I I
;;_.! " � I I I
(�) =^.:tsze Co :nec:iol 0: er.ir.g Connected with Sewer
('i = t:eM Pi:c_ure, Old Opeaing Wates
PAP,TIAL RATE SCNEDULE
?i.iJ43I\G FI�TURE R.�TES: A'0. RATE TOTAL
`�.=�er Fi�.•,:res
r s_��: e.:s �aze C�en:r.g
.._. =?x:ure, Old Cpeninq
Catci 3asin
:<ater :eatcr - to 99,000 BTU
-�;,,OC� S:J to 199,000 BTU
rate= So�ter.er
::ev GroL ;d : :a Old &uildinq
�lec�ric hater Y.eater
;.=.5 FIiTI\G FE:.S:
lst 3 fixtu:es
:.3d:tio�a2 Fixtures
C3a F.3.ge to 199, 00� STU
.^�.�-.?�i �S � AL i E�.�TI O\S
First 5100.00
ea�h add. Si00.00 or fraction
x S3.Q0
x $2.00
x 52.00
X $7.0�
x $5.00
x $10.00
x $7.00
x $5.00
x $5.00
x 53,00
x 51.00
X sio.00
State Surcharge
TOTAL FiE
REIIvSPECTION FEE
i$10.��)
$S.OQ
$2•00
S
S
S
$
S
S
S
$
S
S
S
S
S
S
S .50
S l� O
i
Job Address 1635 Branner P_ss
Depart�eat of Euildings
City of PriZley
Tel. #571-3450
The undersi.gned hereby nakes apolicatiol for a pe^it for thc work ::eze:.1
speci£ied agreeing to do all work in strict accordance with t4e City Co�es
and rulings of the Depart^.ent of Buildir.gs, and hezeby declares t:.at aI1
tho facts and reprosantationa stated in this npplication are true ar.d ocrroci
Fridley, Mn. 1 _� '� _R1 , I9,
O�TN�R Darrell Farr
KIND OF BUII,DING fI'3IIlC
USED AS Y'CS .
TO BE COI�'@LETED ASOUT 1-15��1 �
ESTIMAT�D COST ��•00
OLD - NEW BUILDING PERY.IT NO. PcR:4ZT h0. C7.� l�
�C./ �� ; � � C���
Company
��,��,.-� - ,.
. _`.,;�,.
Signed By
Tel. No. �
ROUGH INSP.
Date
FINAL INSB. f "'/4� ��%
Date
APPROVAL FOR PERYZT / Y/ f�
NINIMUM FEE FOR ANY PLUN.BZNG P^eR'RIT ZS 57-50 pLL'S 5.50 STF�TE SU�3rle2t',E
0
0
_
_
C�TY OF
FRiDLEY
FRIDLEY Ml'tiICIPAL CEtiTER • 6-�31 UtiIVERS1Tl' AVE. ti.E. FRIDLEY'. h1ti 55.t3? •(61�) 571-3-15p • FAX (61?) 571-1�2+7
June 4, 1991
Mr. Kirk Nummela
1635 Brenner Pass NE
Fridley, MN 55432
Re: Chimney Chase Fire Stops
Dear Mr. Nummela:
According to our records and after a field verification, it has
been determined that your townhome has an exterior chimney chase.
As you probably know by now, there has been a lot of discussion and
code research on how many fire stops are required in exterior
chimney chases.
In your townhome development there are five, six unit townhouses
for a total of 30 units. Each of the five structures have four
units with exterior chimney chases for a total of 20 units in all.
Our records indicate that 15 of the 20 units have had siding
replacement work done on them. During the repair it was determined
that most had no fire stops and some had only one. During the
repair of 14 of the 15 units, one fire stop was installed at the
first floor that the chase passed by.
The current interpretation for the number of fire stops for an
exterior chase is that one stop must be installed for each
floor/ceiling or ceiling that it passes by (this is for a new chase
only). We have now adopted a policy that if and when exterior
chimney chases are being repaired (opened up and restored) we will
strongly recommend that a code complying fire stop be installed for
each floor/ceiling that it passes by at the time your chimney is
being worked on. These fire stops do not prevent fires, they will
however slow the spread of a fire up the chimney chase if one
occurs.
Mr. Kirk Nummela
June 4, 1991
Re: Chimney Chase Fire Stops
Page 2
Building permits are required for work done on chimney chases and
your cooperation in this matter will be appreciated.
If you or your contractor have any questions with reference to this
matter, please feel free to call me at 571-3450.
erely,
DARREL G. CLARK
Chief Building Official
DGC/mh
�
_
C�TY OF
FRl DLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (6121 571-12R7
July 24, 1991
SECOND NOTIFICATION
Mr. Kirk Nummela
1635 Brenner Pass NE
Fridley, MN 55432
Re: Chimney Chase Fire Stops at 1635 Brenner Pass NE
Dear Mr. Nummela:
According to our records and after a field verification, it has
been determined that your townhome has an exterior chimney chase.
As yoL probably know by now, there has been a lot of discussion and
code research on how many fire stops are required in exterior
chimney chases.
In your townhome development there are five, six unit townhouses
for a total of 30 units. Each of the five structures have four
units with exterior chimney chases for a total of 20 units in all.
Our records indicate that 15 of the 20 units have had siding
replacement work done on them. During the repair it was determined
that most had no fire stops and some had only one. During the
repair of 14 of the 15 units, one fire stop was installed at the
first fic,�i� that the chase passed by.
The current interpretation for the number of fire stops for an
exterior chase is that one stop must be installed for each
floor/ceiling or ceiling that it passes by (this is for a new chase
only). We have now adopted a policy that if and when exterior
chimney chases are being repaired (opened up and restored) we will
strongly recommend that a code complying f ire stop be installed for
each floor/ceiling that it passes by at the time your chimney is
being worked on. These fire stops do not prevent fires, they will
however slow the spread of a fire up the chimney chase if one
occurs. •
�
0
�
Mr. Kirk Nummela
July 24, 1991
Re: Chimney Chase Fire Stops
Page 2
Building permits are-required for work done on chimney chases and
your cooperation in this matter will be appreciated.
If you or your contractor have any questions with reference to this
matter, please feel free to call me at 571-3450.
ince ly,
�
DARREL G. CLARK
Chief Building Official
DGC/mh
P �62 237 D89
�Certified Mail Receipt
No Insurance Coverage Provided
�� Do not use for International Mail
UlNTEDSTATES �See Reverse)
VOST�L SFKVICE
Sent to
� ���' �Y� ��v ;ti���;ti' �
Street 8 No. � •
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�4� :
P.O.�, State & ZIP Code
r� ��
Postage � �
�
Certitied Fee
Special Delivery Fee
Restricted Delivery Fee
� Return Receipt Showing
� to Whom & Date Delivered
O)
� Return Receipt Showing to Whom,
� Date, 8 Address of Delivery
�
� TOTAL Postage �
p & Fees
� Postmark or Date
�
�
li
�
a
sue�ecT PERMIfi NO. �
City of Fridley ;' �f _; ��� ;:: �
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T� �
f
; � RE-t;€tFT NO.
� COMMUNITY DEVELOPMENT OIV
' j V'�"��', / ��
r � PROTECTIVE INSPECTION SEC �
i �
' � /���1 � CITY HALL FRIDLE� 55432 NUMBEA AEV DATE PAGE OF APPqOVED B�
�""'��� ,�� 612-571-3450 910-F15 9/20194 � �
JOB ADDRESS 1635 Brenner Pass NE
i LEGAL LOT NO. BLOCK TRACT OR ADDI?ION SEE ATTACHED
oESCa. 12 1 Innsbruck North Townhosue Plat 5 SHEET
2 PROPERTV OWNEii MAIL ADDFiES$ ZIP PHONE
3 CONTRACTOR MAIL ADDRESS Z�? PHONE LICENSE NO
Gittleman Construction Corp 7900 Xerxes Ave, Bloomin ton MN 55431 571-1023
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDfiESS ZIP PHONE IICENSE NO
6 USE OF BUILDING
Residential Townhouse
7 CLASS OF WORK
❑ NEW ❑ ADDITION p ALTERATION ❑X REPAIR ❑ MOVE O REMOVE
B DESCRIBE WORK
Deck Repairs
9 CHANGE OF USE FROM TO
STIPULATIONS
Deck construction including handrail, guardrail, spacing, etc. must comply with the
State Building Code.
TYPEOFCONST OCCUPANCVGROUP OCCUPANCVLOAD
SEPARATE PERMiTS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING
THIS PEFiMIT 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 FOFi A PERIOD OF 120 DAYS AT
ANY TIME AFTEF WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STA�LS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SUATAx
AND ORDINANCES GOVERNING THIS TYPE OF WOfiK WI�L BE COMPLIED
WITH WHETHER SPECIfIED HEREIN OR NOT. THE GRANTING OF A PERMIT �2%O.00 �.SO
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 � LS .00 Fire SC �. 27
� PLAN CHECK FEE TOTAL FEE
$15.77
SIGNATUAEOFCOl�RACTOROAAUTH0�71ZEDAGENT ioniEi WHEN PfiOPER VALIDATED THIS IS VOUR PERM17
�
_ �w
S�GNaTURE OF ON�NEAi�F OWNER BU�LDER� iDATEi B�D WSF qFTE
NEW
ADDN
ALTER
[]
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�. l
CITY UF FRID�,EY
SI1'dGLE TAMILY AND DUPLEXT.S R-1 ATdD R-2
Building Permit Agplication
Construclion Address: ���� E� f�.�. n..,! r-1 � r2 1�'�a�
Effective 1 / i /94
��7 ��
I,egal Description: ' �
,tassr� G
Owner Name & Address: i t�.1 �I 5 B 12u C K Nv ��� t� 7ow N N o ���. "1'e� •� 8� I Z SoS
Contractor: C 1�"rl_E��i� til co►.15-TR-UCTI ��.1 Go Q P MN LICENSE #
Address: -��� « �l� ��CE �', ,�.�! ��3�oa �� I �l C'a'rorJ ��-,�( 3 Z Tel. # s-11- I D 2 3
LIVIPdG AREA:
GARAGE AR�A:
nccx ARLA:
UTHER:
Attach to this application, a Certificate of Survey of the
lot, with ltie propased construction drawn on it to scale.
.Lengt(�
I,engd�
L.ength
T1°""r'RIPTIQN OF iMPROVEMENT
Width
Width
Width
Height
Height
HgUCround
Sq. Ft.
Sq. Ft.
s�. rt.
Corner Lot [ J Inside Lot [ J Ft. Yd Setback Side Yazd Setbacks
Type of Construction: C��IC. tz��?�I 2S Cslimatecl Cost: ��o — z7a P�r'��--
Approx. Complelion Date: I c- 3 �- 9�-
(Cos� on Back)
Driveway Curb Cut Widdi Nceded: rt. -I- G F Ft x$ _$
DATC: °1- Za ��F APPLICANT: � �'�i� Tel. # S� 1- Io Z 3
Permit ree
Fire Surcliarge
�Eate Surcliarge
Sd1C Charge
License Surcharge
Drive��vay Lscrow
Erosion Cv��ta ��l
Park Fee
Sewer Main Charge
TO"TAL
S"I'IPULA'1'IONS:
$
$_
$_
$_
$--
$
$
$�
�
$
CITY USC �I�ILY
Pee Scl�e�lule on Iteverse Side
.001 of 1'ernii; Vatuation (1 / 1 G�tli ��)
$.SO/$1,000 Valuation
�u� ��C SnC Ulllt
$5.(}0 (State Licensed Resicleulial Co�ilractors)
All. "A" or Alt. "B" Above
$450.(� Conservation Plan Review
ree Delenninecl, by Engineering
Agreemenl Necessary �] Not Necessary j J
rtJn� PiNJC VtSUCFt I ""' /
� / �!'-i�• ��/
�-�— F 37247
THIS NUMBER MUST APPEAR
ON ALLCORRESPONDENCE
SENT TO US
THIS DOCUMENT GOOD FOR PURCHASES UNDER $1,000.00 ONLY
� �
_ SUPPLIER c� / / %
_ ADDRESS S . l . � / %
> % D /C.) ��� �
CITY OF
FRIDLEY PHONENO. �J�� ' ��/ 'O(�OS
6431 UNIV. AVE. N.E. �� �����-� � G n��
FRIDLEY, MN 55432�384 CONTACT /,r�
612-571•3450
PRINTED ON RECYCLED PAPER.
PAYMENT VOUCHER
BY SIGNING THIS DOCUMENT BELOW I HEREDO AUTHORIZE
PAYMENT AND THAT THE GOODS AND SERVICES HAVE BEEN
RECEIVED OR RENDERED AND ALL CITY GUIDELINES HAVE
BEEN fOLLOWED IN THE PROCUREMENT OF THE BELOW
STATED ITEMS.
DATE RECEIVED
PAYMENT AUTHORIZED BY �
ACCOUNT �TY. UNIT PLEASE ENTER OUR ORDER FOR THE FOLLOWING UNIT PRICE AMOUNT
�v � L ,rs �� ��1� �� ��9���
�n � - o��Cl'� --3,?�
.�C� / -�C� 7 - �I�2 - C�
i5 / - /)rv» - =�nC�'_ n�
'� �`%J� , F �/
� 2 f_. �u fLr
� / ��,g, � i. ��.�
�.
2��v�I�-2 � /�3i �` /�
�r � . ,
� '�/ A�v� ��3 =
¢ � '7� �'t�-�/� & � �� =
�I /c�Df
89 �%,`a �1� _
,�c� /���.
//�
��
�
;���
' � TOTAL �(�, l �
THIS AGENCY HAS AGREED NOT TO DISCRIMINATE IN HIRING PRACTICES ON THE BASIS OF RACE, SEX, COLOR, CREED, MARITAL STATUS, RELIGION,
OR NATIONAL ORIGIN AND HAS AGREED TO TAKE AFFIRMATIVE ACTION TO RECRUIT MINORITIES AND WOMEN INTO EMPLOYMENT. IT ENCOURAGES
FIRMS AND OTHER AGENCIES WITH WHOM IT PURCHASES PRODUCTS OR SERVICES TO DO LIKEWISE.
WHITE, VENDOR — YELLOW, PURCHASING — PINK, ACCOUNTING — GOLOEN ROD, DEPT. HD.
l ivrw.J ......-..'a--
EMR/bas
cc: Mary Heint
Sue Taylor
Jim Reding
,
193U \Ult"Il I\\F�I�Fi}L\ Fl\:�.\C1:U. CI:\l1iR •��x� XERCEti SOl'71 {•\ll\11:V'OLIS. �II\\LSO�1:\ �i-+31 • 16131 H31-?�Ui • P:�.\ ((il2) K�I-li�+
Ix )\C\"IC)�C\ OFFICE: Il IL' �IT)\CiiK� . li tiOI 111 I�llt� f>'IkEET' �>II\\f:VK)1.1�. >II�\Gtic)"I:\;; ��11 � Ibl?l ;;i I�ii . F:l\ ibl_'� iii �rt�l
SUBJECT `��
City of Fridley � � .% ��,-y5
AT THE TOP OF THE TWINS g U I L D i N G P E R M I T � 5 �
f
i �
� l i��.
� • COMMUNITY DEVELOPMENT DIV.
' j 1.-------� .
r � � PROTECTIVE INSPECTION SEC 2!"7 �
�
�lc-� /
� � �"'1 � CITY HALI FRIDLE� 55432 NUMBER aEV onrE �nGE oF" ncvaoveo ev
�"'"��� ,�� 612-571-3450 910-F15 9/15/94 % �
JOB ADDRESS 1635 Brenner Pass NE
7 IEGAL LOT NO. BLOCK TRACT OF AODITION SEE ATTACHED
DESCR. ,3 1 Innsbruck North Townhouse Plat S SHEET
2 PROPERTY OWNER MAIL ADDRES$ ZIP PHONE
3 CONTRACTOR MAIL ADDAESS Z�P PHONE LICENSE NO
Gittleman Corp 7900 Xerxes ��1920, Bloomington MN 55431 831-2505
d ARCHITEC7 OR DESIGNER MAIL ADDFESS 21P PMONE LICENSE NO
5 ENGINEER MAILADORESS ZIP PHONE LICENSENO
�
6 USE OF BUILDING
Residential Townhouse
7 CLASS OF WORK
O NEW ❑ ADDITION O ALTERATION �1 REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WOFK
Repair chimney fire stop
9 CHANGE OF USE FROM TO
STIPULATIONS
See letter dated 6/4/91 by Darrel Clark.
TYPEOFCONST, OCCUPANCYGROUP OCCUPANCVLOAD
SEPARATE PERMiTS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOF A PERIOD OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ ANO 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 �1�7HO �.H9
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CMIARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION ��i1.00 Fire SC �1.7H
PLAN CHECK FEE TOTA� FEE
$43.67
s�cn,aruaeoFCO�r�+ncTOROanuTHoR�zEOnceNT �o^TE� WHEN PfiOPERLY ALIDATED THIS IS YOUR PERMIT
� - Q.-���y
SiGNATUAEOfOWNER�iFOWNEABU�LDEAI IOATE� BlG �NSP ��4TE
NEW
,A�DN
� ALTER
{�
��
�)
-� CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: j�� � k3rZ�--,_[.J, �-� p� �
Legal Description:
Owner Name 8i Address: t Nrl.s B 2u GK �� Tel. #
Contractor: G�i�-rL�r�t�til Go 2i� �- MN LICENSE #
G
Address: ��� B�
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
ZD
Attach to this appiication, a Certificate of Survey of the
lot, with the proposed constructian drawn on it to scale.
Length
Length
Length
DESCRIPTION OF IMPROVEMENT
Width
Width
Width
Height
Height
Hgt/Ground
Effective 1 / i /94
`�36 `7,�
Tel. # g��' �°�
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [] Inside Lot [] Ft. Yd Setback Side Yard Setbacks
Type of Construction: ��-15 ��� �� N 1 r-��y 5-�0�� Esrimated Cost: $ I 7��
Approx. Completion Date: oG-f � I�G14 � p�G����G ��`T �� �� � C 4 � 1�1 �'11
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + Ft = Ft x$ _$
DATE: � I 3��- APPLICANT: � — Tel. #�T I I(��J
Permit Fee
Fire Surcharge
State Surchdrge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAI.,
$
$
$
$
$
$
$
$
$
$
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/i0th%)
$.50/$1,000 Valuation
$800 per SAC Unit
$5_OQ (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Abave
$450.00 Conservation Pian Review
Fee Determineci by� Engineerin�
Agreement Necessary [ ) Not Necessary ( )
STIPUI.A"i10NS:
y ' ' �
BU[LD[fYG PCRMIT FEE SCE[EDULE " ,
"i�hc Cl�icf [3uilding Of�t7cial sfiall, 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 rc�air to any existin�;
(>uilding or s�ructure, u�n a�Plication tt�erefore, reqaire the payment by d�e a��licant for suctt �ermit
<>f� lccs lo the �iiiioun[ hercin bclow sct fort}� and in the mannen c�reia �rovicicxi tt�-wi�_ �
"l'O"1'A L V A LI1 E
� 1 to $500
�501 to $2,000
$2,001 to $25,000
$25,001 to $50,000 � �
�50, 001 to $100, 000
$100,0p1 to $500,000
$500,001 to $1,000,000 �
$1,000,001 and up
r�rE_.s
$IS (Mirtimum Fee is $IS plus surcharge)
$1 S for ficst $Spp p1us $2 for each additioaal $100 or
fraction thereof, to and including $2,OOp
$45 for fust $Z,ppp plus $9 for each additional $1;000
or fraction thereof, to and including �25,000
$252 for first $25,ppp pl�s $6_SO for each additioiial $1,000
or fraction thereof, to. and induding $50,000 --
$414_50 for fiist $Sp,ppp plus �q._SO for each additional
.$1,000 or fractioa thereof, to and including $10(?,000
$639.50 for fust -$100,0pp plus $3_SO for each addirional.
$1,000 or fracfioa thereof, to aad includiug -$500,000
$2039.50 for the first $Spp,ppp pins $3 for each addifional
$1�� o� fraction thereof, to and includiag $I,ppp,ppp
$3539_SO for the fizst $1,000,0(}p plus $2 for each additioual
$1,OOQ or fraction thereof -
DRIYEW,A,y DEPRESSION ESCROVY
(Concrete Curb Streets pnly)
Atternate "A": Removal and replacement of curb and gutter only - Dciveway width plus 6 feet times
$13_SO_
A(ternate °13"_ Re�iiovat acld reptacement of curfi and gutter and insta(I a 3 foot �vide
approach with 6 lnch depd� - Driveway width pius G feet times $IS_75_
VLRIf�CCA"['tON pi� [�pUNDA"I'[0[�t
Yerrnits [or consl�uctio�i wi(1 be� issued a uiinimum of 24 hours from the time of ap�licati�n to allow
(or ��r<>��cr revicw ot tfie proposed Stn�cture and of (he consin�ctior� site_
A C;crtitica�c of Survcy of tl�e lot, st�owin�; ttic location of ttle foundation once it has ii t�as hecri
ce�<<struc.ted will he r<-c�uir�d l�ef<�rc: pr<�eeeclint> with the fran�in}�_
�
� �
, ,,,
;��;:: �:.,
,� ,..,,.
4,. rr
a
:� ��
R'�
I�RlI�I.G1' MUNICII'�1L CCN7'�IZ + Gdl l UfJIVCnSIY'Y /1VC. N.L. rnib�CY, ��1N SSd32 •(G121571-3d50 � rAX (G12) ,571-12R7
Jltlae d , 1991
�i�. �orrti�ne 5odd
5�.1_5 WeS� I3�HI7118r ��b'�3 �!E
T'rlcil�}'� tli�+ 5�432
�:e : Cli�ml�ey �li�se F�z e stags
uear tis . soaa !
J1CCOx'C��.11�� to our reCOzds and �tZter a L-ield verlflez�ti:onF i� has
llee�a tle�ermltied ttit�t yvti�' iowrthome l�:ls �ttt exl-erior cliinu�ey cliase:
I�s you probably 1:no�t uy now j there h�s k�ee» u 1crL• or c�ise«ssi�a� �znc�
cvd� rese��cli olt ho�t m�l�y xire sl:o��s ei� requir.ed i�� extc�rior
clil_m�iey cl��ses +
1:n ��o�t1- L•vwiil�ome develQpme�aE �:itei-e nze ��.ve, ��.�c uni.t t-�tat►l�ot�^e�
i��r � 4�ut�1 0�' 3o unii��+ ��cl� of tl�e L-iv� akruc�u�e� l��v� f�au�-
ua�l�s w�_th e�ci:eirlor cli.�mi�ey cl��ses Cor � i�oL-r�l of 20 ua�i�� Iii alJ_,
ottk irecozds inairat� tli�t 15 0� the 7.0 �nii�s laave taac� s�c�ing
z���l�►Cnmetzl: taaik dcUe on thent, buzlaig l:he repaiz i� w�s cl�?�'.£�Iri.�ll�?Cj
tl�-tl-. tnor�: hac� 1to r�ir� sL-o��s at�d �eme lz�d oi�ly Q��n: C�u��it�q l-1��
�_ct���I_r of 1� o� tl�e 15 u��1L•�y v�nn �ir� ��op was �.�isi:alle{� a� t��a�
�lr�� ��ooir tlial: tli� cliase passec� by.
�i.'I�e cux:�c�i�� i��at�r_�ak��L-dt�on �or tl�e humk�ar of �l�e sto��� �Cc�- �,�
c�x��i.��r ci��se �.� �h�l: olia �to�� mus� u� ir�rt�:ll.��, �o.� :�€�u�2
� 1 c�or/c��_:l ����� o.r C� ��111C� (:�l�tl: �.� �EtS:��� l�}� ( l�la�s .l!: Lvi t� i��� �"i�:��-;s
c��.s�_}' ). t�e l�ave 1��W �zdopk��1 ���o�ie�* L-1��� lf ralac� ��I��ti �ick��_ �.o�-
L.t►..1�»t�e�► cl.��re� ttx��? b*��1tg reJ�c�.��tEQ (v��eri�c� u�? nt�c1 xestox_ecij �+�, c.i; l_1
c;i:i_�Cillr�l_y ?r�LO►mn��acl i:l�ui� d Cvde coltt��ly�_I�g fltp sL•o�� Uc� l�a��1:���ile�c� fi�z
�aal► :�lo�.r/c�llia�y tli�t �.� pna5�Ii l�y d� t1�e L�.m? xo�t.r clzl.i���t��r l.��
beii�q Wo�ked� citi, Th��e fir� ��op� c�o, not preven� tire�, i:hey will
iiowever �1ow � tli� si3re�d of a f ��e up tlie chimney ctia�e if one
occurs� ' � � �
..
11a � Lorrr�ine Svd�.�
JUtI� � � 1991
Ra ! C��im»�y Cifage �"�.�: a 9�vpn
F�ga 2
I3u�lcling ��rm�.l;� are r�quired for taork dona oh cl�imney cl�aega na�c�
you:r Cvopera�i.ori i�y i:t�lo ma�ter wlll �fl ap�rQa�c�t�d.
x�' �ou ar xbur co�tiraa�or have any que���on� �ti�h rvtare►�c� to tl�in
�ae�l•l•.�rt �al�+ar�o t�g1 iirbe �.v calx m� �t 571�3�50.
�' , rely �
1:►11JtIt�sL G. C,j�11IiK
et��ar �u�:�d�r�g o��ici��
ucc/nil�
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C�7Y OF FR1aLEYlNSpECTION D�V.
6A3f Universfty Ave�NE' �
Frid�ey, MN 55432 :�5:�
S72-3604 � �
Siorles
easement
Floor 1
F�oor 2
Floor s
Floor 4
PLUMBING FIXTURE RATES
APPLICA710N FOR ALUMBINCa AND CaAS FITTINC3 PERMIT
MARK NUMBER OF FIXTURES TO BE IlV3TALLEO ON EACN FLOOR
�a�h�` p � r3
,�x : t. ,x. : 'i$ �d3f1 ��Ai� � r a ��001' .x ���la AU�O.
Url�al T�t�: ; 3hower tnk : c
� Tra �p�hf�„7: Drain �a»` ; Wssher
..... ... l�R........ ..
NO. AATF TOTAL
New Fixtures
Old Opening, New Flxture
Bser Di�penser
81ow Off 8asln
Catch Basin
Rain Water Leader
Sump/Aeceiving Tank
Water Treat�ng Appliance
Water Heater —�leciric
Water Heater -- Qas*� �
C,as Range••
Qas Drysr"*
Back Flow Preventer Requlred ()Yes (} No
rype
8 7.0 U
a a,00
$ 5.00
$ 7.00
$ 7,00
$ 7.00
$ 7,00
$10,00
$ 7.00
$,a.aa
$10,00
$10.Q0
$15,00
Effective On January i, 1997
Gas M�9c� Water Heater
Ra�ge Fixt, ,....:: Gas Elec
JOB ADDRESS 1� ��.� 1� l � (��,��1_
The underslg�ed hereby makes application for a permit forthe work herein
epeclfied ag�eeing to do aR work In strict accardance with the city codes
�� and ru�JnBe of the Bu�lding Dfvision, and hereby declares that all the facis
and representations stated in thie applfcation aze true and carrect.
�a, o0
Aeinspectfon Fee $42.00lHr
ALL OTHERS ANDJOR REpAIRS AND ALTFRATIONS
1.5�6 of Value of Flxture or Appliance �� � ��
State 3urcharge
TOTAL FEE
� .SO
.� •
� � , S 997
OWner
Building Used As �
Estimated Coat � �� �
s,Z.�?�____�,_ PERMIT NQ. ������
PLUMBINQ COMPANY�����(�
31QNED BY TE� N0.__�IL[� �<7Q'
Approved 6y �� Rough—In Date �� Final Date � l� C1 �
MINIMUM FEE FOR ANY PLUMBING GA8 PERMiT 13 20.00 ��'.,
PLU3 THE .50 STAT . 3URCHARQE . .
•"COMBUS710N AIR SHAI.� 8E PRpVIDED PER UMC SECTION 504(Aj AIVD 7AB�E 6—A. MINIMUM 31ZE 9 SQ I NCHES,
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'il 1 \�1 _ I ' 1'Y Y •
- - - -- --- - u;:---�*�
The undersigned hezrby verifies that the cxisting chimn�cy or stack:
1- Has bcen carefully e,xamined I,� �
z- IS free fio�a nzst or deterioration
�3 • Has n�o fore�gn objects Iodgod within
4. �s securely supported
5. Meets all cwz-ent Code requiremenu for size
and tvtal BTYJ''s �on�ected
6 Has total heatiug BTU's of �5` `'�
All other BTU's � `�
TO�'AL BTU's � `'°°
7. Has a liner be�n provid�d for water heater
8• Has combustion air been provided for water heater
. �.ix�arks:
�xfS�/r
�
oi)
Yes �' No ( )
Ycs !(� No ( )
Yes � No ( )
Yes fjj No ( )
Yes ( ) No �,�j
Yes �j No ( ��) �
"��C // �� ! �r / / 1
� t ALT S Be' Done:
HE,ATING CO_
Signed By:
�:iT�:
��,,�
/� '.�_
_._---,
��
�5/
TOTAL P.�6
�
SuB�ECT �
c�ty of Fridley 3 0
AT TME TOP OF TNE TWINS g � i L D I N G P E R M I T
; � RECEIPT NO.
� �
� • COMMUNITV DEVELOPMENT OIV. �D / q
r � L • � PqOTECTIVE INSPECTION SEC. ���
;-.•. A,��"','� CITY NALL FRIDLE� S51J2 NUMBER pEV O�TE ►�GE O� �vvnOVEO B�
1 J� 612-571-3450 910-F15 6/27/00 � �
JOB ADDRESS 1633,35,37,39,41,43 Brenner Pass
1 LEGAL ��T NO. BLOCK TRACT OR A�DITION SEE ATTACMEO
OESCR. —G F� 7-12 1 Innsbruck North Townhouse Plat 5 SHEET
Z PROPERTY OWNER MAIL AODRESS 21P PHONE
Innsbruck Townhome Association 651-224-5482
J CONTRACTOR MAIL ADOFiESS ZIP PHONE IICENSE NO
Gar�ock-French Roofing corp, 2301 E. 25th St., Mpls., NW 55406 612-722-7129 0000142
� ARCMITECT OR DESIGNEii MAIL A�DRESS 21P PMONE �ICENSE NO.
S ENGINEER MAII AOORESS ZIP PHONE LICENSE NO
6 USE OF BUIIDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION � REPAIR O MOVE � REMOVE
8 DESCRIBE WORK
Reroof Townhouse Building (Tear off)
9 CHANGE OF USE FROM TO
STIPUTATIONS
Underlayment must comply with the State Building Code.
P�rmit tnspection Cards
l�liil Bs Maflsd
To Nomeowner To Post
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCVLOAO
SEPARATE PERMITS ARE NEOUIRED FOR EIECTfiICAL, P�UMBING, MEATING,
VENTII.ATING OR AIFi CONDITIONING
THIS PERMIT BECOMES NULL AND VOIO If WORK Op CONSTRUCTION zONING S�. fT CU fT
AUTHORIZED IS NOT COMMENCED WITHIN 60 OAVS. OR IF CONSTRUCTION
OR WORK IS SUSPENDEO OR ABANDONEO FOR A PERI00 OF 120 DAYS AT
ANV TIME AfTER WORK IS COMMENCED NO DWIG. UNITS OFFSTFEET VARKING
1 HEREBV CERTIFV THAT 1 MAVE REAO ANO EXAMINEO TMI$ APPLICATION 6 STALLS GAf1AGE5
ANO KNOW TME SAME TO BE TRUE AND CORRECT. ALl PFOVISIONS Of LAWS yAIUATION $URTA%
AND ORDINANCES GOVERNING TNIS TVPE OF WORK WILL BE COMPLIED �21,194. %S �IO. S9
WITH WNETFiER SPECIFIEO MEREIN OR NOT THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTMOiiITV TO ViOIATE OR CANCEL TME pEqMITFEE SACCHARGE
PROVISIONS Of ANV OTMER STATE OF LOCA� LAW REGUTATING coN. ��49 25 Fire SC �21.19
STRUCTION OR THE PERfORMANCE OF CONSTRUCTION
PLAN CHECK FEE TOTAL F
$38 . 3
S�GN�TUpE O� CON'AACiOp OQ �UT�+OQ�1E0 �GENT iO�iE� EN FOP ALIDAT 0 �S IS V UR PEpMIT
�r� rV �
S�GN�TUAE O� OwaEQ��� OWHEA BU�IDEA� iDATEi ,. �ti5� �i<<E
SuB�ECT
City of Fridley
AT THE TOP OF TME TWINS g U I L D I N G P E R M I T
r
� .
� �` _ COMMUNITV DEVELOPMENT DIV. 572-3604
r � L � PROTECTIVE INSPECTION SEC
i
� � �'�'1 � CITY MALL FRIDLE� SS�J2 NUMBER pEV D�TE P�GE O:
�""'�"� ,�' 763-571-3450 9� o-Ft 5
9/10/02 � �
JOB ADDfiESS 1635 Brenner Pass NE
�IT NO.
33067
APGAQVED BY
�
1 LEGAL LOT NO. BLOCK TRACT OR ADOITION SEE ATTACHED
oescR. 3& 12 1 Innsbruck North Townhouse Plat 5 SMEET
2 PfiOPERTY OWNER MAIL AODRES$ ZIP PMONE
Barry Weiner 1635 Brenner Pass NE 502-9937
J CONTRACTOR MAIL ADORESS Z�P PHONE LICENSE NO
Hendel Construction 4997 Page Ave NE, Rogers, MN 55374 428-7992 20192308
� ARCHITECT OR DESIGNER MA�L ADDFESS ZIP PHONE UCENSE NO
5 ENGINEER
MAIL AODFESS
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION l� REPAIR
8 DESCRIBE WORK
Rebuild chimney chase; add firestops to meet code; reside chase
9 CHANGE OF USE FROM
TO
PNONE LICENSE NO
O MOVE O REMOVE
STIPULATIONS
Firestop per section 708, 1997 Uniform Building Code.
TYPE OF CONST
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL. PIUMBING, HEATING,
VENTI�ATING OR AIR CONDITIONING
TNIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING
AUTHORI2ED IS NOT COMMENCED WITHIN 60 OAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONEO FOR A PERIOD OF 120 OAVS AT
ANV TIME AFTEfi WORK IS COMMENCED. NO DWLG. UNITS
I HEREBY CERTIfV TMAT I HAVE READ AND EXAMINEO THIS APP�ICATION 1
ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS Of LAWS VALUATION
AND ORDINANCES GOVERNING THIS TVPE Of WORK WILI BE COMPLIEO
WITH WMETHER SPECIFIEO NEREIN OA NOT THE GRANTING OF A PERMIT �3�SOO
OOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE Oi7 CANCEL TME pEqMIT FEE
PROVISIONS OF ANV OTHER STATE OR LOCAL LAW REGUTATING CON-
STRUCTION OR HE PERFORMA E OF CONSTRUCTION �97.ZS
PLAN CN�CK f EE
Licen S
S�GN4rUA O�CON'aAC1OQO.♦UT�QpIzED1GENT IDATE� W FN Fif
tioT�QE O� OwaEQ��c pwrvEQBwIDEQ� �O�TE� I Bt
. �..
OCCUPAI
SO fT
STA�LS
5. 0
Y AL
P �OCCUPANCVLOAD
CU FT
OFFSTREET PARKING
IGARAGES
SURTAX
$1.75
SAC CHARGE
Fire SC $3.50
TOTnI EE
07.50
D HIS IS R PERMIT
�/��/
r, � r
NEW ( J ClTY OF FRIDLEY Effective 1/12002
ADDN () 6431 University Ave NE, Fridley, MN 55432 (763) 572�604 Bldg Insp
ALTER (] SINGIE FAMILY AND DUPLEXES R-1 AND R-2
BUILDiNG PERMIT APPLICATION
�
Construction Address: %� 3� ��°''"� ^�-� a� S
Legal Oescription: /,�tU�� h���
Owner Name & Address: Sa r,� QK. Tel. # �"� — 9� 3�
Contractor. ���_('�„ �u��� MN UCENSE # 2�� qa'3� �
Address: ��� ��.cyc �-e1e /l� �e�S Tel. # �-� �7`19�-
LMNG AREA:
GARAGE AREA
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length V1ldth - Height Sq. Ft
Length Width Height Sq. Ft
DECK AREA: Length � Width HgUGround Sq. Ft ,, �
QTHER: '�� ' l -lS ' ' ,r f i�r) �- .-� 1. �: �,, /%% f < <
,,' � _ /C�:�i,v�` 1�=f.fS�_
Construction Type: �� cF.�l� Estimated Cost: $ 3�v .U�
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x� _$
D�eTE: � � l �' b� APPUCANT: ��-- �k� Tel. # �Lg -�'l 7�
Call (763) 572�604 for Permit Fees if mailing in application or Fax to 763-571-1287 if using c�edit ca�d and we will
call you tor card number.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Par{c Fee
Sewer Main Charge
$ �% �S"
$ - � S �'
� �� r���
$
$ �� Ct.�
$
$
$
$
CITY USE ONLY -
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1200 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee DeteRnined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ ����� � �� � STIPULATIONS:
� -/�`��'t--��. ��8 /�'� � ! G,
�
BUII.DING PERNIIT FEE SCHEDULE
T1�e 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 to-wir.
TOTAL VALUE
� 1 to $500
��Ol to $2,000
�'-.001 to. �2�,000
�?5,001 to $50,000
�50,001 to $100,000
$100,001 to $500,000
$�00,001 to $1,000,000
FE ES
$23.50
�?3.50 for tirst $500 plus $3.05 for each additional $100 or
fraction thereof, to and inc(uding $2,000
�69.2� for tirst $2,Q00 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 p(us $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
�1,000,001 and up $5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - Driveway width ptus 6 feet-times $17.00.
VERIFTCATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow 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. New Houses Onlv
Builc�ing
Inspectio�s
763-572-3604
763-502-4977 FAX
DATE {
SITE ADDRESS
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
� � � 1j� BUILDING Permit No.:� ��I-'6C�"I �-P�o
RESIDENTIAL APPLICATION Received By:
CITY OF FRIDLEY Date �'� J U
EFFECTIVE 1-1-09
�� YOUR E-MAIL ADDRESS ���-��1�+���� �1'Y���� • ✓��
�1 � �( P,l'U'� P,� �r.�.S 5 �r' i �� � �.�L YYV'1 �i�) � 3 . �•-
❑CONTRACTOR
ADDRESS: 1 b�'fJ /V �71 ��1��i IJCt_S`� CITY
PHONE: ��b3 ;�-o� - � +� 5 �
NAME:
STATE LICENSE #
��� � � �X�
ATE '{ i ZIP . ,55 y3 �
EXP DATE
_CITY STATE ZIP
PHONE Fp}{
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN T1LE
J� DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
❑ NEW HOME CONSTRUCTION O ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELfNG
DESCRIBE WORK BEING DONE: Rc�lqc-c.. '�WO D t C k��( ,`S !_� �.0 K��'S L�1( L��„i: h, S�a.`�'S
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SO FT
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
WINDOWS
IN EXISTING OPENINGS ❑Yes ❑No
OR FOR NEW OPENINGS-DESCR[BE SIZE OF
OPENING CHANGES &
TYPE OF. WINDOW TO BE INSTALLED
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
LOCATION OF WINDOWS
NUMBER OF WINDOWS
,�
I� S�
BASEMENT REMODELING SUBMIT:
l. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION [NCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structures
and proposed project.
2. Two sets of construction plans
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
S�NG T E 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ �2,�-�� ,�j� OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
5�-I . l
$
$
$
$
$
$ �-I 1 , 6
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$2000 per SAC Unit (Plans to MWCC for determination)
f�+6ft= ftx$22=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary (
Make checks aavable to: Citv of Fridlev
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
Attach Sti
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 1 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 plan in the case of a 1 work which requir s review and approval of plans.
SIGNATURE OF APPLICANT 1�{�ly�-1ly ��� � i�� PRINT NAME �Cay-h I2e�� t� �r��n DATE � d"�� l
Page 2- Building Residential Application
BUILDING 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 to-wit:
TOTAL VALUE FEES
$1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000 $23,50 for 1 S` $500 plus $3.05 for each additional $100 or fraction, to and
includin $2,000
$2,001 to $25,000 $69.25 for 1 S` $2,000 plus $14 for each additional $1,000 or fraction, to and
includin $$25,000
$25,001 to $50,000 $391.25 for 1S` $25,000 plus $10.10 for each additional $1,000 or fraction,
to and includin $50,000
$50,001 to $100,000 $643.75 for IS` $50,000 plus $7 for each additional $1,000 or fraction to and
includin $]00,000
$100,001 to $500,000 $993.75 for 15t $100,000 plus $5.60 for each additional $1,000 or fraction to
and includin $500,000
$500,001 to $1,000,000 $3,233,75 for the 15t $500,000 plus $4.75 for each additional $1,000 or
fraction to and including $1,000,000
$1,000,001 and up $5,608.75 for the ls' $1,000,000 plus $3.15 for each additiona] $1,000 or
fraction
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to
allow for proper review of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
Fax: 763-502-4977
_
C[TYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UIVIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
BUILDING PERMIT APPLICANT: PROPERTY OWNER
I, 1�CL�-i��2� ��fSorl understand that the S
requires that all residentia! building contractors, remodelers and roofe sf b'tain a state
license unless they qualify for�5 ific e�emption from the licensing requirements. As
the owner of the property at �(o _J�J �2v�� j��5 , Fridley, I
am exempt from the state licensing requirement only if I am not building or improving
this property for purposes of resale. By signing this document, I attest to the fact that I
am improving this house for my own use and do not intend to sell it. I hereby claim to
be exempt from the state licensing requirements because I am not in the business of
building or remodeling on speculation or for resale and that the house for which I am
applying for this permit, isl the first residential structure I have built or improved in the
past 24 months. I also acknowledge that because I do not have a state license, I forfeit
any mechanic's fien rights to which I may otherwise have been entitled under Minn.
Stat. 514.01.
Furthermore, I acknowledge that I may be hiring independent contractors to pertorm
certain aspects of the construction or improvement of this house and I understand that
some of these contractors may be required to be licensed by the State of Minnesota. I
understand that unlicensed residential contracting, remodeling, and/or roofing activity is
a misdemeanor under Minnesota law, and that I would forfeit my rights to
reimbursement from the Contractor's Recovery Fund in the event that any contractors I
hire are unlicensed. �
I have also been informed and acknowledge that by listing myself as the contractor for
this project, I alone will be responsible to the City of Fridley for compliance with all
applicable building codes and city ordinances in connection with the work being
performed on this property.
Name Q �,� � �Qh.a.e�v�
Date (o R �00 �
The Home Depot # 2813
3220 C'�;NMARK AVE, EAGAN, MN 55121
(E51) •II��-2323
Tue Jun Or 13:05:53 2009
This Project cannot be priced because not all materials are carried in stock.
See Store Associate for prices on non-stock items shown in Bill-of-Materials.
TIM KUNTZ
6X6 DECK
220908
3D View
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The Home Depot # 2813
3220 D�NMARK AVE, EAGAN, MN 55121
(651) 452-2323
Tue Jun 02 13:05:53 2009
This Project cannot be priced because not all materials are carried in stock.
See Store Associate for prices on non-stock items shown in Bill-of-Materials.
TIM KUNTZ
6X6 DECK
220908
Deck Layout
The Home Depot # 2813
3220 D�IVMARK AVE, EAGAN, MN 55121
(651) 452-2323
Tue Jun 02 13:05:53 2009
This Project cannot be priced because not all materials are carried in stock.
See Store Associate for prices on non-stock items shown in Bill-of-Materials.
TIM KUNTZ
6X6 DECK
220908
Post Layout for Deck 1
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The Home Depot # 2813
3220 D�NMARK AVE, EAGAN, MN 55121
(651) 452-232�
Tue Jun 0� 13:05:53 2009
This Project cannot be priced because not all materials are carried in stock.
See Store Associate for prices on non-stock items shown in Bill-of-Materials.
TIM KUNTZ
6X6 DECK
220908
Deck Dimensions for Deck 1
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The �Home Depot # 2813
3220�DENMARK AVE, EAGAN, MN 55121
(651)452-2323
Tue Jun 02 13:05:59 2009
TIM KUNTZ
6X6 DECK
220908
Construction Specifications
deck 1:
Construction Method = Beam to Side of Post
Footing Type = Pier In-Ground
Live Load = 40
Dead Load = 10
Decking Spacing = 0 1/4"
Joist Spacing = 16"
Beam Spacing = 48"
Post Spacing = 72"
Decking = 5/4X6 - Western Cedars No. 2
Beams = 2X12 Treated Southern Pine No. 2
�oists = 2X10 TreatPd Sni �thprn PinP NO. 2
`�Posts = 6X6 Treated Southern Pine No. 2
Deck Height = 80"
Diagonal Bracing = Yes
Deck Skirt = No
_�_
----Joist Overhan _=_�2"
�.._ _�
�`8'�1'Yi6verhang = "
Decking Deflection Factor = 360
Joist Deflection Factor = 360
Beam Deflection Factor = 360
Pref Decking Size = ML5/4x6
� _-.---Pref Joisf Si�= fix'n'r"��
r"P'efi�eam ���Size = 2x12
Pref Post Size = 6x6
Diag Brace Height 1= 24" in
Diag Brace Height 2= 24" in
Railing 1:
Railing Height = 36"
Baluster Spacing = 3 3/4"
Toe Space = 3 3/4"
Stair 1:
Step Width = 36"
Step Height = 72 1/2"
Step Rise = 7 1 /4"
Step Run = 11"
Stringers = 2X12 Treated Southern Pine No. 2
Risers = 5/4X6 S/OWalnut Veranda Decking
Treads = 5/4X6 Thompsonized Southern Pine No. 2
Railing 4:
Railing Height = 36"
Baluster Spacing = 3 3/4"
Toe Space = 3 3/4"
Railing 5:
Railing Height = 36"
Baluster Spacing = 3 3/4"
� Toe Space = 3 3/4"
Railing 2:
Railing Height = 36"
Baluster Spacing = 3 3/4"
Toe Space = 3 3/4"
Railing 3:
Railing Height = 36"
Baluster Spacing = 3 3/4"
Toe Space = 3 3/4"
�he Home Depot # 2813
3220 �DENMARK AVE, EAGAN, MN 55121
(651 } 452-2323
6/2/2009
TIM KUNTZ
6X6 DECK
220908
Materials for Deck:
Qty UOM SKU Use
23 EA 226573 Balusters
1 EA 155959 Beam
7 EA 731867 Bottom Rail
1 EA 167055 Decking
6 EA 167136 Decking
7 EA 167055 H Top Rail
2 EA 255781 Joist
1 EA 155465 Ledger
1 EA 601065 Post
5 EA 264784 Railing Post
1 EA 155465 Rim Joist
1 EA 255781 Rim Joist
3 EA 155959 Stair Stringer
6 EA 167894 Step Tread
1 EA 168768 Step Tread
7 EA 731867 Vert Top Rail
Standard Materials: NOSKU, Standard Deck Materials
5 EA 865889 2x10 Joist Hanger
2 EA 209715 4x4 Post Foot Brkt
2 EA 927708 Anchor Bolt
2 EA 538892 Anchor Nut
2 EA 538981 Anchor Washer
4 EA 544208 Beam Bolt 4x4
4 EA 538892 Beam Nut
4 EA 538981 Beam Washer
10 EA 169765 Conc Pier In-Gnd
1 EA 258132 DiagBrac Joist
1 EA 454141 DiagBrac Joist Nail
1 EA 439398 Flashing
1 PK 462810 Hanger Nails 2x10
1 EA 454141 Joist Framing Nails
5 EA 538981 Lag Bolt Washer
5 EA 928607 Ledger-Bolt
18 EA 544208 Rail Post-Bolt
18 EA 538892 Rail Post-Nut
18 EA 538981 Rail Post-Washer
Decking: OPTMAT, - Western Cedars No. 2
1 EA 222686 Deck Screws
1 EA 735068 Fascia Screws
2 EA 500667 Fascia Board
The total cost of in stock materials is $1059.59 plus tax.
This Price does not include any Special Order Items.
Please see Store Associate to adjust the design
or to price and order items.
This estimate was created on 6/2/2009 and is valid for 3 business days.
Parameters from UBC.cod parameter file.
Description
2X2-8FT. D/BTR GREEN CEDAR S4S
2X12-12 #2 PT
2X4-8FT. GREEN STK CEDAR S4S
5/4 X6-8FT. GREEN STK CEDAR DECKING
5/4 X6-12FT. GREEN STK CEDAR DECKING
5/4 X6-8FT. GREEN STK CEDAR DECKING
2X10-12 #2 PT
2X10-8 #2 PT
6X6-12 #2 .60
4X4-8FT. GREEN STK CEDAR S4S
2X10-8 #2 PT
2X10-12 #2 PT
2X12-12 #2 PT
5/4X6-10 PT PREM WEATHERSHIELD
5/4X6-8 PT PREM WEATHERSHIELD
2X4-8FT. GREEN STK CEDAR S4S
LUS210Z DOUBLE SHEER HANGER Z-MAX
PB44Z 4X4 POST BASE Z-MAX
CARRIAGE BOLT GALV 1/2 X 6
HEX NUT GALV 1/2
FLAT CUT WASHER GALV 1/2
CARRIAGE BOLT-GALV. 1/2 X 8
HEX NUT GALV 1/2
FLAT CUT WASHER GALV 1/2
80L6. QUIKRETE CONCRETE MIX
4X4-12 #2 PT
16D 3-1/2" HOT GALV BOX 5 LB
DECK LEDGER FLASHING WHT GALV 8FT
10D JOIST HANGER NAILS
16D 3-1/2" HOT GALV BOX 5 LB
FLAT CUT WASHER GALV 1/2
LAG SCREW GALV 1/2 X 6
CARRIAGE BOLT-GALV. 1/2 X 8
HEX NUT GALV 1/2
FLAT CUT WASHER GALV 1/2
DECKMATE SCREW, TAN, 3 IN, 25L6
DECKMATE SCREW, TAN, 2-1/21N, 5LB
7/8X8X12 KD STK CEDAR BOARDS
F�arameters used for Deck 1: 40 psf live load, 48 inch footing depth.
WARNING:
THIS IS NOT A FINAL DESIGN PLAN. VARIATIONS IN BUILDING CODES, SPECIFIC ARCHITECTURAL
CONSIDERATIONS, OR SITE CONDITIONS MAY REQUIRE CHANGES TO THIS DESIGN. YOU ARE RESPONSIBLE
FOR THE FINAL STRUCTURE, CODE VERIFICATION, MATERIAL USAGE, AND STRUCTURAL SAFETY OF THIS
DESIGN. BE SURE TO CHECK AND VERIFY THE DESIGN WITH YOUR LOCAL ARCHITECT AND BUILDING
INSPECTOR.
THE COMPANY ASSUMES ABSOLUTELY NO RESPONSIBILITY FOR THE CORRECT USE OF THIS PROGRAM.
ALL OUTPUT SHOULD BE EXAMINED BY A QUALIFIED PROFESSIONAL TO DETERMINE IF THEY ARE
REASONABLE AND ACCURATE.
Building � ���
Iaspections��b�#�
763-572-3604
763-502-4977 FAX
dATE_______�
i SiTE ADDRESS
� THIS APPA.ICANT 1S:
1 PROPERTY
dWNER/
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� CONTRACTOR
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i SU6MIT A COPY QF
� YOURSTATE
i LICENSE WITH
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I
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From: 612 822 5408 Page: 2/3 Date: 10l14/2010 11:18:52 AM
� 1VIECHANICAL P�it No.:ti
�(�RESIDENTIAL A,�'�L�CAT Received By:
CITY OF F'RIDLEY ��
EFPEGTIVE 2-19�09
r..�� YOUR E-MA1L ADDRE55
O OWNER �ONTRACTOR
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ADDRESS' � G17 r
PHONE: ��p�' �Q�� �%�S�
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COMPANY NAME: �IZv� �/�n�G�h '
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ADDRESS: � il.�
PHONE �� Z - �Z Z
J�SINGLE FAMILY 0 TWO FAMILY
TYPE OF WORK: I� NEW �e�.ncEtvt�rr
DETATr,ED DESCRLF'TION OF WORK
CITY_���/�G y STATE l�.4/�IP .��J�
EXP DAT'E �Z�I D
FAX �I,�z— ��l —9��� _
❑ TOWNHOUSE
❑ ALTERATTON/REMODEL
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FEES ARE BASED ON S10.U0 PER FI?[TURE, E�CCC WIIERE NOTED. FfXTURES: (IND[CATE TOTAL NUMDER OF EACH�
P'
Equipnicnt In,qrallcd MFG: OD �'+'L�C�n MODEL: 517.FJB'tU o
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MFG: MODEL: SIZFJB'iU
A/C $25.00 FIREPLACE (GA5) �lS,UU GAS RANG61OVEr1 S10.(X)
NR TO A.[R EXCHANGEER SIS F7REPLAGE (WOQD) $3,5.00 NEW GAS GRILL S10.00
_BOILEA 535.00 �PURNACE $35_{� CAS LJNIT HTR 510.00
CHIN�NEX l.�N ER $14.00 GA5 DRYER 5I0.00 POOL HEATER 535.00
I DUGT WORK �510.00 _GAS PIPING S10,00 _VEN7fC,ATpR $15.00
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TH15 i5 AN APPL[CAT[013 FOR A PERMIT-NOT VALID UN[7L PROCESSED
Z hereby appty for a buildun� penmit and I acknowledge that the information above is complete and accurate; that the woz#c wil� be in
conFormance vc+ith the ordinanccs and codes of the Gity of F�idley a�ad with the Mininesota Cozastcuction GvdaK; that I undcratand this is
not a permi� but only an application for a permit and work xs not to start without a pexmit; that ttae work will bc: in accordanct with the
approved plan in the c�.yc of all w�chn xequ� review and approval of pIan�
SIGNATUR� OF APPLICANT PR1NT NAME .�� C.{I�r�.--J DAT� < �/I3/�G
" City of Fridley
Buzldxng Inspections Department
643I University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
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