AF - 41942; c;
Telephone: 424-8844
CHERRIER WINTER & ASSO�CIATES, INC.
REGISTERED PROfES3/OMAL • LAND BURVEI►ORS 3621 • 85th Avenue North
&ooklyn Park, MN b5443
� �ertificate o�f Su
PROPERTY OWNERs Anoka County Community Action Program
Legai Description: Lot 29 Except the west 10 feet of Lot 29,
Lots 30�31 and 32�RIVERVIEW HEIGHTS, Anoka County, Minnesota.
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�1 heroby artii`y thet thi: wn►ey, plan, or repon wa� preparod by me or
und�r my dtrect wpen►taion and that I am a duly Repistend Land
Survsyo� under�a�ewa of the Sa �oA Minneat�
Date �O 27-88 Rp No. 6
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Scal• 1 inch equah��'fat
o Indiat�s Iron Monum�nt
Book�.�. Paae��...�
Job No. � 3g9 -�
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_ FRIDLEY
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CIVIC CENTER • 6-131 UNI�'ERSITY AVE. N.E. FRIDLEY, MINNESOTA 5543? • PHONE (612) 571-?�150
April 26, 1988
Jim Plemel
Anoka County Courthouse
Main Street
Anoka, IrD�i 553�3
Dear Jim,
As per Minnesota Statute 282.01� Subdivision 1, the Fridley Housing and
Redevelopment Authority hereby requests that the Anoka County Board of
Commissioners xithhold from public sale tbe tan forfeit property located at
the intersection of Broad b Fairmont�(PIN: 03-30-2k-43-0011) in Fridley�
Minnesota.
The Fridley HRA further requests that Anoka County cornrey to the Fridley HRA
the afore mentioned property Por the specific public purpose of providing a
site for the Anoka County Community Action's IIrban Homestead Program for low
and moderate income housing.
It is my understaading that you will provide the HRA with an application for
transfer of the property, and upon its co�pletion vill preseat the application
for approval by the County Board. If you would forr►ard the application to me,
I Will process the necessary doc�entation and return the completed documents
to you for presentatioa to the Board. IIpon oa�mpletion of the application and
conveyance proeess, the HRA t+ill file With the Anoka Cour�ty reeorder a
eertificate Por rights oP reverter.
I appreciate your assistanae in this matter. If you have any questions� or
require additional information or doe�entation from the HRA, please eall me
at 5? 1-3�50, Eut. 160.
Si n�er y, �
Cd%���
Samantha Orduno
Management Assistaat for Eoonomie Development
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M E M 0 R A N D U M
` T0: JOCK ROBERTSON, HRA ERECOTIVE DIRECTOR
FROM: SAMANTHA ORDUNO� MANAGII�NT ASSISTANT
SIIBJECT: TAX F�RFEIT PROPERTY FOR ACCAP
DATE: MAY 6, 1988 '
°a ���� - �`�`'T
The application for conveyance to the HRA of the tax forfeit property requested
by the �noka County Community Action Pro�ram's Urban Homestead Program has been
completed and mailed to Anoka County. The matter will be considered at the next
meeting of the County Board. Upon their approval, the County will deliver a
state tan deed with a right-of-reverter.
The process should t� completed well within ACC�P's ti�frame Por rel.ocatin� the
house onto the property.
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^ F03-30-24-32-0011
57593-2540 Commissioner McCarron
Fridley
,_E Fo o. 2b87-`�-t �RM „i T..:�u� r•�,.n lun. rt
ENTAL SUBDNISION FOR CONVEYAN(� OF
pppLICATION BY GOVBRIVM .FORFB�� �
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.Uiuur no(�r .Sl�dul�•++ 1l1;4, .\rrliu�� :R1.�
F�? 41 � eY.._.�.42.1� � n9... a3��� �X�.�P!P.�1.�.._A.�1.�:k►4l �.k�Y_.....,
Im t7u ;ilatter oJ EAe dpplicatdon of .... ........ .. ... C�ain Laada
. 4 pp�erarr�e++taL SwbdG•iawre. iw' a ConreUanoe o� .
Fr3d1eX...Iiousinc� .and....Redev�e..,l.m.�??R'Y .�.n..�.t..'.Authority.._ .............._„.,and ceLie��
Comu � .................. ...
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1. TkaE appilea►+t i� a(aJ .._�Go„v.,�r{.11it�.I1�d�,....r.�.l�4S��X�.�7..4ZAl ....................._..._....._.__.._.. .
a. That (b) .........................
Anoka.................... ..._.._...,
, nt'e boanda,rir,a fn Eha Cmw�iy o/ .......................... �•'e s t
� ,�. That tharo ia eituuted wbthin appiiea .
eetia tan+a auertbat a+ 1ato,�a: ......i�.t....2.2......�t�..XCr.�a.�ta....I.Lcl.gh�.G.....(Exac�.t...thc
ocrtai.n tac-f�f '
10 feet thereof) Lot 90, I.ots 31 and 32. Biatkthereofeonlfi'f°eandtof
MN according to the ltap or p MN
Anpka County, ister of Deeds in and for Anoka County,
record in the office of the Reg
Tax forfeit ••••-•••••-••••••~•°�°•
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,�. T]�at aaid Eanda are (o ...
Public Use
or tlu fol�oratnp Pw''P�e°' (d ._ ........................__.
........._.,
.i. Tkat appGtaant deairea to obttun euid ktnd i
GT. Tkat thero ia need /os aueh Zande tor t1�e fol2owing rtaeoae: �'.XQ.V.�a.�...�...°�°k��..._f�.�:....kk��....Anoka
County Comr.►unity Action's Urban Flonestcad Prograr: for lo�a and Mndernte
income housin�Ignt p�� �t �� �� � �� � tb �or tke wa � �''0E"`
Ti'herefore appli ,
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Ite............................................................................................
�tate of �inttegota, �
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coun� of ........................ • �e aua
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or himself. that they ere reepeotiusly the ...................................................................................
a�rorn. deposa and aay� eaah i
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t1u maEtera statr.d
and PPliaation and k now t wntenEe E �i a� �_ .
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tha.t they hnve rend i �° � -1 / / ' o
th.ere�» are true. the ort �' T r�! 1- S-� /��... .:G..�!�.-f•:,.t.:l,� .........................
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�;�� �e;,LTCR J. t1UL:.v�Y > YoEaryPublte �!:.•'••"•'�•'•.' ...............County,Minn.
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ti r�'.t � Norar,t vc'.uc- tai� +f�oTA -- � �• "
` tt� RAMSEY COUNTY pZr � ••••.• °•°°°°
� " .11y eom.m,tsaion ex ee ....... .:....�r..%.... . ..%..1.....,�..� .
blyCommiss�on E�plras Oct.07,1988
fa/ Stan (a �i�d Uateiodar dsecribed bf ��� ol [merdni bed7 � 67 ��� °� � thn ew
(b) Su�e (aen aho�m( aut o e, �! ���i� J w9.
�y rtpu�rt. attacEiGY CnD� �( �Rd O/bb'��t �aCl►
�c) DescnDe nam�a d ���de, uce of eurmnod�na p* f
;d) G�.e ��atammt e( I�c�� ae ta cha uee W ba �ol euc6ly�.
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� RBSOLUTION OF COUNTY BOAEtD UPON APPLICATION
if'SEREd3, Lke Couri.ty Board oJ..........._ ...............ANOKA..................,,....Countp, .hlin�a�ola, hae e.ramtned
into Wie ddleQatione or Ehe apptdcatFom o/ ..............................»........_................_........_........._.............._............_................ ..............
dat�d ... '_.. _............._ ........... ..................., IJ.........., Jor Ehe aa��eyanre oj eertain la�da Ehersin de�oribrd;
nou�,
Thore orr, ba tE resolued b the Count Ba�rd o ,,......,ANOKA ,.,...0 .Alinuuota,
f 1/ U f............_.__. ......._ ......................... mcR.ty.
Niat it hereby ........approres said appdiocction nnd reemnmenda tii¢t Ehe �arru be ................................�rnnEed.
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COM/EfjJ BOOT(� O' ddllL COU�tLEb/
�tate oi �tfnne�ota�, �
c�� o� ... .. .... ......... avotu►............... .................
I, . ................. ..................................................................................................., eownty arcde,Eor and elerk of tke Coantn Bonrd
oJ..._...._..._ ............................._..............................Cou,aEy, rltfrant+oia. derrbD �fll that I ba�ve arm,pa.rrd thi jorepoing
ooyy o/ ruolwtion o/ Ehe Cora�ety Baard oJ �zdd eouatq mttb tke ori�t.�at reeorrl Ehe►tor ia !he nunutea oJ
the proeeediapa oj aatd ba�rd a0 a mc�r.�ep daty A�eTd........._.�...........W_....___......:..__..........,18..........., ce�d th�b fdu
aame Q a. true and e� oopq oJ eold orby�tnal rao►d aud oJ the roAoL tbarooJ, and Wiat m[d rseol�rtton
u�as da�q adoPfid bp e�¢id boasd aE aaid noa�Wa��. I�urElyar ar�fq fJ�a4 faa appLiealtaae neJer�sd to ta eatd
r�solutios !B hereto ailaeAad.
�lf'dtna� niy l�awd asd aral tkL._.._............._._.._....._... ..............._.ddyo�._....__.:..._......._._..........._._...........,18...........
Co�rwtq duddto� aad Ciark oJ EAe Countb Bourd
_....._........_._...... ANOKA ...»...»»...........Cow�ty, .Afirenaola
OFFICE OF TXE C0.4f.gI33lOWE8 OF T6Xd?ION
St. Paul, .�lfinn .. ............_......_...................._.................., 18............
Dpma due �ra.tion nf tlee witleta apyliaatton !t ta ordered Eleat Ehe �arru � and it ia lureby
rejteted drsa.nted.
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Commtsrionar of Tasation
By.................................................................. ..... ....... .. .......... .
Depufy
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City of Fridley
AT THE TOP OF THE TWINS
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� �` _�_�_ COMMUNITY DEVELOPMENT DIV.
� v � PROTECTIVE INSPECTION SEC.
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� _ �"'1 � CITY HALL FRIDLEY 55432
�•"'� � �'� 612-571-3450
SUBJECT
BU ILDING PERMIT
NUMBER REV. DATE PAGE OF
910-F15 ��5�88 � �
JOB ADDRESS 580 Fa.i.rmont St�eet N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 29^32 J Riverview Heights
2 PROPERTY OWNER MAIL ADDRESS
_19579
ECE�Q�IPT NO•
� 91�a
APPROVED BV
SEE ATTACHED
SHEET
Anoka County Community Action 8008 Highway #65 N.E., Spring Iake Park 784-2443
3 CONTRACTOR MAIL ADORESS Z�P PHONE LICENSE NO.
Same
4 ARCHITECTORDESIGNER
5 ENGINEER
8 USE OF BUILDING
Residential
7 CLASSOFWORK NEW
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MAIL ADDRESS
MAII ADDRESS
O ADDITION ❑ ALTERATION
21P
ZIP
E LICENSE NO.
PHONE LICENSE NO.
❑ REPAIR � MOVE O REMOVE
8 DESCRIBE WORK
Construct a 26' x 41' Foundati,on; House to be Moved Onto Lot from 45 - 75th Way
Move 22' x 22' Garage Onto Lot; Construct slab
9 CHANOE OF USE FROM TO
STIPULATIONS
Provide sod in the front and side yards. Provide City with copy of
verifying survey before capping foundation, Provide a hard surface driveway.
Driveway Escraw:l0' + 6' = 16' x 13.50 =$216.00 , House must be brought up to
meet a11 current building codes such as plumbing, electrical, mechanical, bedroom
egress windows, smoke detectors and energy code.
lst SEWER & WATER LOCATION: (West) "Y" 150 E of M.H. on Broad Avenue; Water 11' E
of 5ewer. "Y" ELEV: 832.08 TOP OF FOOTTNG; Minimum 835.08
2nd SEWER & WATER LOCATIONS; (East) "Y" 198` E. of M.H, on Broad; Water 10' E of
Sewer. "Y" ELEV: 834.91 �OP OF E'OOTTNG: Mi.nimum 837.91.
THE CITY OF FRIDLEY DOES NOT GUARANTEE THE SEPARATE PE67IV1��'S RE(�i1�R�� ���
i'`I�IS � TA�IS FOR1t1V ORMATOION PURPOSES ONNY, ���`��' �'�����'�� PLUM�lN� �.�o� S��p�
TYPEOFCONST. OCCUPANCYCiROUP OCCUPANCYLOAD
$����p��(v11�R��U$� L�,OR ELECTRICAL. PLUMBING. HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS
I NEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �'
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND,ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPUED $2j.�OOO
W1TH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING CON- $278 � Q�
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
�_ T $N/A
SIGNATURE OF CON i RACTOR OR AUTMORIZED AGENT IDATEI EN
S0.
STALLS
CU. FT.
REET PARKING
GARAGES
\X
$14.50
SAC CHARGE
$550..00
TOTALFEE
$842.50 + DW
D THIS iS YOUR PERMIT
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�� �� Cit1► o� Fridley EEfective 5/L86
AmN I) R-1 14UID 1�2
AL�33t [ i
Builcling Petmit Applicaticn
Qmstructian Address: _ �c�C� ��. ��� ,� � � � ms � �' � � � �� �.
I��gal Descriptian:_ � � i a� �S' - .3 � ��o � � � (l.� r '` � r � � , •� r��- ��
Owr,er N�e i Adare�s: �«•9 � , � �o � � �- �`�,�> � � � �` � �1. # � � �� � � �'�
�
tbntractor : �� � ��� �' � � � � �el. � ��°'� � °��,�
Address: ,� �� � � ��° :=�-.�� 5.. �� � �� �. �
Attaci� to this appl ic,ation, a Certif icate a� bluvey a�f the
lat, wfth the propcsoed constructian dree�rn on it to scale.
�IQd (� II�RWPl��
� . T+engtt� ��� � i�lidth _ 8eight �. i�t. / �G�
C�RAGE ARFAs Leilgth a� e Widt..'. o? � 8eic�lt .�. Pt. •�'�`�
�$�$�� LEI��1 / � Wl�l ° � 1 H� /GtOLt1C� � Stj. 1�. �' � �
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�rner Lot [ l Inside Lot (�l Ft. Yd Setback �� Side Yard Setbacks %�
�pe c� Q�nstructian: ����'� � E�timated Cost: S� �.�� O. �C.�
Approx. Cbmpl etion Diate :_ Q� F°�'�` .
,� � t A Alt. 8
Proposed Drive�ay Width If New Opening Is Desired: /� �� S ��� �� S
Width +, 6' � See Back Page
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IY�iTE : � - S - � � APPLI�IJP: �-� ; �t �..� f , .�
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Plemit Ppe
state Siuc�arge
SAC �arge
Driva�ay Eecrow
htk Ppe
Bewer !lafn marge
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CLTY OSE CI�LY
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Tel. � � � �- � 5-��
P�ee Scfiedule on Reverse Side
8.50/81,000 Valuation
5550 per SAC Onit
Al� '7�• or Alt. 'B• Above
Fpe Dete=mined by P�gir�eering
Agreenent Neaessary [ � Not Neaessary [ ]
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�e �►ief Building Official shall, before issuing permits for the erection of any
building or etructure, o�r for aqy adciitian to any euisting building or structure, oc for
any alteration or regair to any eYieting building or etructure, upon applicatf�n
therefae, require �e payment by the applicant for eu� permit a� fees to the amount
berein belcw set forth a�d in the manc�er berein prov3ded ta�wit:
'�TAL VAi+�1E
Sl to 5500
6501 to 52,000
52,001 to 525,000
525,001 to 550,000
550,001 to 5100,000
5100,001 to 5500,000
_�
S15 Qyinimun �1ee is S15 p1u�s surcharge )
S15 for first 5500 pl�s S2 for each additional 5100 or f raction
therec�, to and including 52,000
S45 for f irst S2, 000 glus 89 for each additional Sl, 000 or
fraction therea�, to anc7 irrluding 525,000
8252 for first 525,000 pl� 56.50 for each additicna�l �1,000 or
fraction thereo�, to � including 550,000
8414.50 for first 550,000 plus 54.50 for each additianal 81,000
or fraction thereof, to and including 5100,000
5639.50 for first 5100,m00 pl�s S3.50 for each additicnal 51,000
or fractian thereof, to and including 5500,000
�:�;J,001 to 51,000,000 52039.50 for the first 5500,000 plus S3 for each additional
Sl, 000 or f ractiori ther�af, to and including Sl, 000, 000
81,000�001 end u� 53539.50 for the first 51,000,000 plus S2 for each additional
51,000 or fraction thereof
(Concrete Curb Streets Only)
Alternate "A': Renoval and replaoement a� wrb and gutter only - Driveway width plus 6
feet times 513.50.
Alternate 'B": Renoval and replaoement o� cvrb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plt� 6 feet tin�es 515.75.
�si���►': V �:� �;" i�_U, �: M �;��
Permits for oonstruction will be issued a minim�nn of 24 hours f rom the time of
application to allcw for proper review c� the prc�oeed structure and of ti�e ccnstr�tian
eite.
A Qertificate a� S1�rvey o�' the lot, shvwing the lowtion of the faa�dation once it has
been c�nstructed will be required before prooeeding with the fr�ing.
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ANOKA COUIVTY COMMUNITY ACTION PROGRAM, INC.
8008 N.E. HIOHWAY 65 • SPRIN(3 LAKE PARK. MN 55432 • PHONE 784-2443
Electric
Heating & Air
Plumbing
Construction
Foundation
Moving
Es c avat ing
LandscaAin�
PERMIT BIDS
Job Estimate for 41 75tn Way
To be Moved to Lot 29 or
Fairmont and Broad off
East River Road
$ 1,000.00
750.00
2,800.00
5,000.00
7,609.00
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6,000.00
3,000.00
Job Estimate Total $37,559•00
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_
°�crnroF
F[t[DLEY
CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450
October 4, 1988
�� �v
`-�i ���
��I
Mr . Jisn Arbu ck le
Anoka County Community Action PiOt�P�
8008 Highway #65 N.E.
Spring Lake Park, MN 55432
Re: Final Inspection at 580 Fairmont $treet N,E., Fridley
Dear Mr. Arbuckle:
A final inspection was conducted on Septembe,r 2�, 1°�88 of the above address
and the follow�ing item� were noted which must &e coQnpleted fiefore' the structure
can lie finaled:
1. Provide City with copy of verifying survey.
2. Provide�.egress windows in eacfi bedroom:
3. Provi:de smoke detectors on b�oth levels of house.
4. Bolt west beam of deck to post.
We will expect the above items to be completed and a reinspection called for.
If you have any questions on these items, please feel.free to contact me at
571-3450.
Sincerely,
DARREL G. CLARK
Chief Building Official
DGC/mh
ATTACH: UBC Section on Moved Buildings
_
CIlYOF
FR[DLEY
CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450
December 16, 1988
Mr. Jim Arbuckle
Anoka County Co�unity Action Program
8008 Highway� #65 AT. E .
Spring Iake Paxk, MN 55432
Re: Final Reinspection at 580 Fairmont Street N.E., Fridley
Dear Mr. Arbuckle:
A final reinspection was conducted on the above property ori November 16, 1988
and it was noted that a11 uncompleted items in our October 4, 1988 letter to
you had been completed and were approved.
The structure has now been finaled by all o� our inspectors.
If you have any questi.ons on this matter, please feel free to contact me at
571-3450.
Sincerely,
DARREL G. CLARK
C�ief Building Official
DGC/mh
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 l+'AX:
: 580 FAIRMONT ST NE
: 033024320011
: RIVERVIEW HEIGHTS
: LOT 29 BLOCK J
: HEATING
: RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
571-1Zii7
PEItMIT NO.: 2004-00201 � �� %
�
DATE ISSUED: 02/12/2004
C ..
'� ` � „
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
REPLACE FURNACE (WARM AIR, ARMSTRONG, 75,000 BTin
VALUE OF APPL OR WORK 0 # FURNACES
# GAS DRYERS
ENTER VALUATION
APPLICANT
ROYALTON HEATING & COOLING
4120 85 AVE N
BROOKLYN PARK, MN 55443
(763)424-8333
OWNER
LONGBEHN, TAMMY
580 FAIRMONT ST NE
FRIDLEY, MN 55432
0 # GAS RANGES
0
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 worh
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 of any other state or local law
regulating construction or th�erforc�ance of construction.
Bldg
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
HEATING REPAIltS/ALTERATIONS
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 39606
1
0
30.00
0.00
0.00
0.00
0.50
30.50
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TPiE BEt..t�W MUSi BE FillEb tN WHEt� FtEF�ACI�IQ ��- BURIViNC� �P�IANCES OR TNE
APP�L1C�i'@ON WtLI. BE RE'TIJ�2NED
rn���a�� � L,��r��* rrrx�r ���vnR r�� co�a��not� e►�Q �!�ROF�c,�v�n�
yy��y ��A�in� �A P�riati �j h,ren�p, G'�e undersi�ned h�reby veri%es �at the
venting has be� examin�d and Ig fr� frar� rust, deteriar�tion, o�svuctions,
and i� securety suppotted �nd fir�sta�aped wh�re �quired. Yes �No (
Th� v�nt�g sys4am is pia56dPVC anet meeks all cucrerrt codes artd manufaciu�er
spep�6aUans inctuding sizing, lenglh, number of elbows and tennination. Yes � No (
The �nd�rsigned alss� verifi�s that the r�plac.eament urat �s a listed a�mbly
�nd meets the c,e�rrtent cod�s and manufacture's spe�cabons. This does
indude AGA-GAMA Cat,egary I Central Fumace V�ti�� iables for fan
assi�ted �d n�l draft �ppliances•
Thp �xi�etin��nnn�+� �c4ien aic i� SiZ�� ettd 'tt1522�1ed to me�t the current codes
and manufecture�s specifcicatinns.
Wp�c3n l@alJit�3d iA ir��t�l�a���a cesn ��_c�;or+ Qir� �t vY�li t�� $�rtd a�td iitst311ed
to meet the a,rrent codes and manu��acro�lrets speciflcadons,
W}�� ir+��j�gl6np� A na±w y�r�t�^=,iye +,+, tne under�ignad hereby veri�es that
st is a ksted assernbly and r�ets the cu�rent cales and manufac#urer's
speeifrcations. This does mclude AGA-GAMA Cat�gary I Central Fumace
Venting �Tabies forf�n asslsted and i�atural drafc appllances.
Is ttx-� cumrn� vent and vent conne�tors sized and instafled corTedly after
an applianc� has bean remov�d from ttie common vent and vented
separately a� per current codes.
Yes�Na (
Y85 ) No i
Yes(�a{ )
Yes No f )
Yes r ) IVo ( 1
�ynli ru p T�,�P ^r7d �'vi��l�Rmmon Ve�� �{pnf nran �tar lnferrs ation
C � YlEQ ��- .
Appii�nc� �1 Type T ^��'� BTU In�i � �y gn Assist or Nai .,�
Appliaru� #2 Typ� �� STU lnput �,�G� �st�t1 c� a
A�pli�tr,c� �3 Typ� ��` ` B�U f nput Fan Assistec� or 2t
Tata1 Appliance� Totai Bha Inp�.rt ,�, .,
e-f�1-e� a ����;'t-�
CommAn Venc TYpe ,�._._._.___ Vent Height __�; Pi�met�r � inches �``� �; ss �
App{bance #ig Ver12 COntt�ctor Helght ft Length � ft Diameter �r � in Type �
,4p�lf�,c�s #� V�nt Ganr.�cter H2ight �n Len�th _�ft [�;ameter _ "/� _ in Tmpe �
Appllarice �3 Vent Connestor Height ft Lengt� ft Diam�ter on Typ� _„_,
ld ��/J9• i i.�'/�<e
HEATlNG C0: ��-�.'"�— -
5,�� gy: 4120 -�5ih AVENU� �ORTH Dat� :--
�KLYN PARK, MfV 55443
763-424-8333
�r,,._ -. ,�
�
;� ���`�° �r�
o-�
'r�-L. s��s/ as
HEAT LOSS CAL�CiJLA'I70NS DEPARTMENT OF INSPECTION [yII�pp�,(g, �, .
Qleathentrips Csuide Conatrxction IVo. Insulatioa �.
Wiadow: I Doora Refereau Out. Wall lnt. Wall Ceilia� Roof Floor Kind �w
ei-- o es— 0 19_ —
L .I �., R��► �o�� w�t► � t�;�,� Fl.� [t�m ��o� w�
Windowa and Doors—Crackage and Area Wiadows aad Doors--Crackage �nd Area
Wldth H�I�bt Ne. 01 idnul t Ana f' Wldtb H�I�At No. ot Llnwl t� Ar�a
Ne. o! paa� of p�o� Ilfbl� ot cnek p. tt N. of p�a� ot y�e� Il�bt� et cnct p. tt.
�' (a 7 ,� � a i0 3� 8' 1 �?
.� � � • �
.� �
Coe1. Btu I
lnfiltration
Glati �
E=p. wall
Net e :p. waU �
Iot. wall
Ceiling '
Floor
T`otal Btu. �
Required aq. h. E.D.R, or �q. ini. Q/A. L,eader area �
�1 �.fl.� r�� �� w� H�b�
�Windowa and Doors--C�ackaQe and An�
wiace x.isee ao. ot �.m.ar t�. wr..
No. ot pana ot p�n• Ilspta ot enct p. tt
��K � « Qvr
'��G-°� �^ � 3
1� a n
Glas.
E�. waU
Net ezp. wa0
to�. Wau
Ceiling
Floor
�Total &u.
Required sq. ft. ED.R. or sq. in�. R/A I.eader �roa
Fl. Room � L,enetb Widtl�
Windowa and Doon--Cracka�e and Area
w�ain x•�sei No. oc �e•.� n. wna
No. ot pa�• ot p�a� II�b4 et araet p. [G
��4
In6ltratioa
Glau
Eup. wall
Net e�cp. waU
lnt. wall
Ceiling
Floor
Total Btu.
�q. ft. E.D.R or p. ins. WA. Leader �re�
sm I
Bc� I
C,lass
Esp. waU
Net esp. wal)
Imt. �xaU
Ceiling
���
Total Btu.
i '�.
Required sq. h. ED.R. or aq. in�. WA. l.eader area
Fl.I [t�m I t�os� w�dc�
R/iadowa and Doors--Crackage and Area
w�eie Hel�At No. o[ tm..i n. wr..
No. ot paa� o! p�n� It�bu ot cr�ek p. ft.
Btu
�y
�
n
?� �
��
1a61tratioa
Gl�u
iap. wall
Net e�. wall
Inc. wall
Ceiling
Eloor
ToW Btu.
Required �q. f� E.D.R. or tq. ins. WA l.eader ares
F7. Room 1 L.ea�gt�a Width Height
Window� and Door�-Cracka�e aod Arca
� IAtA .ISec Nw ot I.Isal tG Ar..
Na e! yte• ot p�n� Ilteta et cr�ek �p. tt
Coef. Bcu
lnbltsation
Cdaw
Exp. waU
Net ezp. wall
Int. waU
Ceiling
Floor
'fotal &u.
Reauired w. ft. ED.R or w. ins. WA. Leader area
..
�: ` HOUSE HEATING TEST RECORD
`°,�
ADDRESS � � � `�� - `�' w _ '� " p
_ APT. FLOOR _
OCNPANT � �T �'� . _� r ,- � '� ,, P r`=r � .� - OMINER
HEAT 1055 DATE TG. INST. �
CITY r � �^ ✓�� UBURB
SOLD BY INSTALLED BY
El�ehieal Work' Br Cas Lin� Br
TYPE OF HEAT GA FA .�_HMI STEAM SPACE HTR. UNIT HTR. OTHER
s
GAS DESIGN CONVERSION
MAKE �-'� �'� �.-'�,�" -°�_ t'
' AIAKE OF BURNER
Model � �, a-P".,� j �
_ ' � AAod•I
Swial '' � AAo:. BTU Rofiny - — - - -- - ,
� ,�. ,� .,�-`�
INPUT �—� e--.�. �` � MAKE OF FURNACE
INod•I
CONTROL S q � i1 �`�
THERMOSTAT�'� �"` H�ot Plu9 ��L_ V•nt Sis•
Valv '���''` � KIND OF LINER �/��� SIZE �gA NONE
Limit f�'� '��°� �— �—� Droh Hood Rpularor
Limit S�Miny ��a Filt�►s Si:� �G� � ���-� ��umb�r �
Fan Ssttiny � Chimn�r Location Insld� �'�• Outaid� �
Pilot Typ� =�� .: f� - — - C]�im�ny Consf►uefion �---' f'1 � `°, ��.
Pilot Maks
Pilot Mod�l Smek� Bomb Wirinq °'��
Pilot Timing Droft �--�°` T�st Ts0 '��
L.W. Cut Off Door Pr�ssur� Liqhtinq Inst.
�ri; / `�
Prosw�e P�re�nt C0� _—C.f1� Dat� T�st�d ° "
�^ 7 9 ' '' �, � ,�;;, o
I�ut CFH ' ��2_ P�rc�nt O� • �° Companr T�sting . '�' � °, ' c� '
Srock T�m ���._ , 9 ``�� � , ` '' y
P• ���, P�re�M CO Nams of T�:t�r
�' -,4 .� ' d,
Fwm 235
Building
Inspections
763-572-3604
�oO �
SITE ADDRESS �
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
E-MAIL ADDRESS
O OWNER ��,CONTRACTOR
SUBMIT A COPY OF STATE LICENSE
YOUR STATE LICENSE ADDRESS:�
WITH APPLICATION pHONE i�I.Y/.
PROPERTY TYPE
PERMIT TYPE
❑ TWO FAMII.Y/NEW
❑ ADDTfION
❑ BASEMENT FINISH
O DECK
TrrE oF woRx: �
❑
DESCRIBE WORK BEING DONE: �1� �
SIZE OF IlVIPROVEMENT.
ROOFING
NUMBER OF SQUARES �
GARAGES
PROPOSED STZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
WINDOWS
IN EXISTING OPENMGS ❑Yes ❑No
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENWG CHANGES &
TYPE OF WINDOW TO BE INSTALLED
O SIDING
❑ SWIl�M�TG
❑ ADDTfION
❑ REMODFLIt
EXP DATE
? y� a o aG
SIZE
❑ DRAIN TILE
❑ OT'E�R
Permit No.
Received By:
Date Rec'd:
LENGTH WIDTH HEIGHT
'HOUSE & GARAGE
ATTACHED GARAGE
DETACHED GARAGE
❑Soffit
0 Trim
0 Fascia
LOCATION OF WINDOWS
NUMBER OF
T&�',"!1'LIP .� t � �
BASEMENT REMODELING SUBNIIT:
1. Existing Floor Pian
2. Proposed floor plan
3. List of structural members W be used
Ft.
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the exisdng 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 MATERIAIS:
(USING 997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ ,�/� OCCUPANCY TYPE
Permit Fee
Plan Review
Surcharge
Fire Surcharge
License Surchazge
SAC Charge
Curb Cut Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
Total Due
$ � � 3�2
$ �
$ _�l',fl
$
$
$
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
(.0005) times the total job valuation — Minimum $.50
.001 x Permit Valuation (1/10%)
$5.00 (State Licensed Residenrial Contractors)
$1450 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$20=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary (
Make checks pavable to: City of Fridley
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
Attach
I hereby apply for a building permit and I aclrnowledge 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 whic e uir r,� view and approval of plans. �
SIGNATURE OF APPLICANT ����,i���� PRIlVT NAME � ��%/'v DATE (J �C/ O,��
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:
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
763-572-3604
Fax: 763-502-4977