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AF - 45141�Cit of Fridle Minn. � Y Y� BUILDING PERMIT N° 4 3 9 0 Date: ........��....."....----_.-/__./..."' ..._� � .....................- Owner: .. Builder .... .. .... . � ....... -. -.- . ..�.��A�.�._........._........ Address� -............ --� - � ............... . ..................��---..............--��----��--�--� �-� -....... Address � L CATION F BUILDING No. ..�0'�.�� Street .....l .... .. ........ .......... .- � ._.....................�.f.......'��-..... . Part of t ............._........... � .................... � ......... Lot __._�� ................ Blcek ......_....__.:T...._.._._..._....._..... Addition or Sub-Division ...�'��.... ....._..... ..- -_........_..... CornerLot _ ...... ......_..........__ Inside Lot ....._...._..__...._.........._.. Setback . .......--......_.........._...... Sideyard ._.........__....- ._..._._.__.........- --...._......_... Sewer Elevation To be Used as: �eC;��^�^�'�� _. Foundation Elevation DESCRIPTION OF BUILDING L/ . ♦ . .. , f� Front ..:7..°�`� Depth °?G�_ lO Height .._ f.�:..'� Sq. Ft. �/.Q�. Cu. Ft. �.� �3 / ___. Front Depth Height ..._ ---___.. Sq. Ft. .____._.._....... Cu. Ft. _ .............___.._...__..... --..__.. - - _. ..... _ Type of Construction . _____ _. _..... _ _-_._. Est. Cost _ j.�i_ O. �� .'.... a be Completed ._... . ... In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all p•ovisions of ordinances of the city of Fridley. ""—� - ��--�--��G'�%--•s�?� - --�--- - -�-- -- . ................ ..__.. `a� In consideration of the payment of a fee of $�l...._-"" ',—permit is hereby granted to_..._..._.____...._........._......_ ............._... ....._ .................................................................... to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this pernut may be revaked at any time upon violation of any of the provisians of said ordinances. _.�-- Building Inspector NOTICE: This permif does nof cover the eonslrucfion, inafallation for wi�ing, plumbing, gas heating, sewer or watee. Be sure to see the Building inspector for separafe permits for these items. 4 ` ` �� 0 � . � aC � �a . � �> � � C� - H p� � C .c.. = O � } 'S � V a � J � W � U � . W 4 � � � J F- � a 0 � .� � � . � � . � � a � �, ` aa � a A � � � �� y w ��y .�'� � 0 a�� , �� o�� .� ,� � o �� Q�� '�CO nf�y� a'°y� '� o'� a� o�ro� �� c�°iuvi° :�y�� ' �'� a �� (y y„� N �g°.0 .�� '�°�N A� ��o � v.�� b "��00� � � �N v � �� N� � $ �o �s � �� E �� O o 0 0 000� � 00 �[i � N � . . . O : ; $ O : : o � . . � � . . � a4 ° `� B U � d +� � I y � ^J � :' O � 1.an A KI +=' � 4 °� w � d O y ,N a � � � a� 3� �a�a� cva � � .p � � � � a � � � � � .. ., �� z , y � � � � � � � � g '� � a" U i�9 � o � � a�i N V � � � � � z O bC 5 H W O � � � � � O S O O � OC C'� �[! � N � 3 O O a v p � sFS ers �a va °o, °o �°n �°n o GO CO N N �fi : : : : : � � � � : o �9 � . . . p W b . . QC.� o : : � � w � ' ' � � y :� g � � � : +�o `° W er �$ °i I ; y� � W � � � � � :i� E. �7 � a aJ � o � -°,�`� 3 `� ' ��y � � p � � F .� A � y � � -'� � � ' 3 � ; � � a � V � � � � � � I � w � A :� .g � �, � x � A c'r tr y y o � N M � � c'�i c'�i f� W z � z N � � O ��,, � � � � � � � r� � : � : � ' d :w . � � a � � � O ti� a � .-� A' Rf • bD i� M � M � �. � W O x a .'7 � a 0 � O 'L! � � N � � � � � � � U .. � Ey z N N � � � � � � o� a� �� E E�+ l �r � v� �ss a�r °o P�G ,�r, �°n c t[i � � CV : o � � � z � � � �, : : N P � � o � g 0 � o 0 w N � � � � � � y W � a W � � � a � �, y � w z � � a H � � � 04 R+ t7 C9 a x � A w � � m y � � � � err eEa � a '�$ o � N � w N �-../�. a F W W z � � a z �' N �' o � � z � � � o ��' U H W p4 x x F �w�e a � W a [ 4 n � Q � � � � 0 ti � _ � � � � � ��2-�� rY.�.--� �,�/�� HEAT LQSS CA�ULA�I�1'�5 DEPARTMENT OF BUtLDINGS ''�` '`' , MINN. A.S.H. .E, Weatherstrips Construction No. Insulation Guide Windows J Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied Yts—No � Yes—No 19._ . Fl.� �.; Room L.engt /' Width L�O�'�ieigkt � Fl.� Room L,ength ,S��iL" Width /p'�� Height Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area \Vldth Hefght � No. ot �Llneal tt. Area Wttllh Hefght No. ot Lineal tt. Area No. ot pane- o[ Dane . lights ot crack aq. it. � No. ot Dane ot pane Ifghb �� ot orack sa. [t. t .S` � 2 2- /' d � n �a.,� �� O / / i D ! ?� Coef. Btu In6ltration //y K s zb k �° Glass ,�b So �s� D � F�Scp. wal! Net exp. waU �� Int. wall Ceiling � / Floo� TotaT Btu. Required sc}. ft. E.D.R. or sq. ins. W.A. Leader area Fl.) Room � Length 9�( �� Width Window� and �oors—Crackage and Area Wtdth Helght No. o[ L1nea1 tt. Ares Na of pane o[ psne tl6hts o[ crack q, ft. Infiltration f�L � t Glaas p ' Exp. wall 7 � Net exp. wall � Int. wall , Ceiling Floor ' Total Btu. Required sq. fi. E.D.R. or sq. ins. W.A. I,.eader area FI. • Room � Length //// Width /3 Windows and Doora—Crackage and Area Width Helght No. ot Lineal tt. Area ��, No. ot pane �ot pane. �tlghts ot crack . sp, tt. � 3 i /G �a � 3 Z. Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor �� .. �-�'y� �� , , � ��- ��, - i Tota1 Bta Required aq. ft. E.D.R. or sq. ina. W.A. Leader area FI.I Room I I..ength S,�'' Width �' Windows and Doora--Crackage and Area Wtdth HelBht Ido. oL Lineai LtC Area No. of psne o[ pane IIBht� ot crack sq. it. f i/ �Z �i i (� /h Bcu � 31 t�' Infiltiation I, j o D Glaas F�cp, wall d ,�'b Net exp. wall Int. wall s�7 Ceiling Floor '� Total Btu. Coef. $tu ' In6ltration 23 /Z cjo �� ' Gfaas !� sy � Exp. wall < �/ ' Net exp. wall / /O ;,2 !� /� Int. wall ��eiling � �a / � � loor al Btu. ` 'red sq. ft. E.D.R. or sq. ins. W.A. L.eader area C�� ' F1.� / jtr • Room ! L.e Windaws and Daors—Cra< � Wtdth HetYht No. < No. of Rane of D�ne � lishl �I � �� f � Infiltration � Glaas Eup. wall Net exp. wall Int. wafl �� i _�m � � _ ., � �� __� _ �• m . �_- 1 � ,�'Cf�` Width �~ Height : and Area dneal tt. Area it crack �Q. tt. �i i7 Ceiling 3 � , Floor Totat Btu. Required aq. ft. E.D.R. or sq. ins. WA. l.eader area �� Btu �� S� � z � � �.,,�-��-'�' H�AT LOSS CA�ULt�lTIQN5 flEPARTMEiVT OF BUILDINGS "'- �� Weatherstcips A.S.H.V.E. Construction No. lnsulation Guide MIN Wirrdows I` Doors Reference Out. Wall Int. Wall C.eiling Roof oor Kind How Applied � Ye3—No Yes— 0 19_ Fl.� ' Room Length /'�Width `�° Height � F1.J Room } Length Width Windmws and Doors—Crackage and Area Windows and Doors—Crackage and Area �Yldth Helgt�t No. o[ Llneal ft. Area Wldth Height No. o[ Llaaal ft. Area No. ot Dane- ot Dane . 1i6fits ot crack eQ. tt. � No. ot pane ot Dane ❑ghts � ot crack ea. Lt. � / 2 / / 3 � z l /r? � ,f� / x'�" 6 �'� / �� Coef. Btu Infiltration y K � - ,v InLltration Glass a? Glass Exp. wal) � Eag. wall Nct exp. wall f� 6� Net exp. wall Int. wall Int. wall Ceiling 6 S' / 2�D �. Ceiling Floor Floor Total Btu. �� Total $tu _ - — — - _ _--- Required sq� ft. E.D.R. or aq. ins. W.A. Leader area FI.� Room Length Width Height Windows and Doors—Crackage and Arca � � Width ��.Helght No. ot- Lieeal ft.. Area No. ot pane ot pane �Il�hte o[ crack �q• tt. In6ltration Glasa Exp. wall Net exp. wall Int, watl Ceilin Floor �� — Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI � 11Vindows and Wldth No. o[ pe�ns � � 1n61tration Glass Exp. wal) Net exp. wall Int. wall �Ceiling Fioor 1'otal Btu. Room � Length Width �ors--Crackage and Area �ht No. ol Ltneal tt. Area I .ne pghts of crack ep, tt. , �� Reguired sq. ft. E.D.R. ot sq. ins. W.A. l.eader area Btu Coef.� Btu Required sq. ft. E.D.R. or sa. ina. W.A. Leader area Fl.l Room (1.ength Width Windows and Doora--Crackage and Area No. f of nat e ot pans liahb � o,t cra k pr [t. Infiltration Glasa Exp. wall Net exp. wall Int. wall Ceiling Floor 'I�otal Btu. Required aq. ft. E.D.R. or sq. ins, W.A. I..eader area 1�1.) Room I Length Width Height Windawa and Doors—Crackage and Area VJfdth Het`Dt No. ot Lineal ft. Ares No. ot aane ot nane Itehu o[ crack ea. tt. Inhltration Glaas Exp. wall Nec exp. wall Int, wall Ceiling Floor Totai Btu. ReQoired aq. ft. E.D.R. ar sq. ins. WA. [.eader area Btu :.� �� , � � a R � � � � � d� ° :� ,� � m � Q � � O � .� � � � m 4 M a �a � p o 30 o� o `' � � � �� A �S � � I' '�� " � � � � oo� 3 � �s d�� '�'3 U � u .� w �'i � �Mi i�l Q ti .Ci �•�i V ��R F L u,�, � � ti�"Y �°�� a� y � � � � V V � � "'� �i tla U C� N 'p � `° � a ��x�� °°� �y � �� b � � � 0 �'d �,� �N � q �°�x� � y � � � � � d � � � � d � '� • p, o �� a�� F J = w r ; < c� s z • r S`JNIN3d0 5VJ 3JN1M �� sv� Y3HSVM o� SNISYB H�1V� SNIVNa � aooi� •san�►�s '1Nf10� •�Niaa '� � $AVfll HSVM � �' �' S71NIS SNisve � b S8f11 , v O q � �� rnN�an (� X � • � 1f31YM � m d w x � •� zyl � GQ H N M eN • 'x' � 0 z � � a b / � tl � ` � z � �� a i10 � � � � � ;� � y � .� '�C ,� O � � a U cA o 'd 3 o � ° � z � � � � � i � � � H w o m $ o p' �� I .� .��.:�:�:. � W J � W _ U � W a J H � a x ] °a ap � E• 4 E+ � str v�r a� v� vs etr ��. N O N O N .� .-� .�i M N M iN �S 9C k k i� iC O z : : : : � : . . . . � . . � o cio . . °c � m .� : o ov (/] : .� a� � � w � �, g' ° O a � 0 � � � w � � ° � PG iC a� a�'i 'O �+ +' ..�'r � �"" W .fki � � y Q � � W W � x � � d � v � � 3 r � 3 x z� Z U� Z oa � a z w a � E e� ta �� °o � N k k iC O z ; � � 0 � � o 0 . y N �i � � ° w � p � z M � M � H °�' d C9 � � P „ � v 10 h � � : G4 . � : E+ b . c� ; m : a � Z : � E+ ' � o � 4 •� V dd �a� a a � �.. _r .� �.�� r_,..^ . .,, ,�. .: _ _. .,,_�,�-�- , �- _ � - .. . . � -�� . � - � � 5UBJECT . ._,. . ��y of Fr�aley a 140�9 R7 THE TOP OF THE TWINS • r BU ILDING PERM ; � R EIPT NO ` � `��_ COMMUNtTY DEVELOPMENT DIV. ''% � � �� PROTECTIVE INSPE�TION SEC. / . 1,- .. ... � .. � . . . , . . � � �� 1 /"'Ql> � CITY HALI FRtDLE� �� 55432 . NuMeea REV. DATE� PAGE OF APPROVED 8Y . �----� ' `•' s� z-ssaaaso 910-F45 5 23' 77 � � 10B AD�RESS S2S� F].�.LYtO�f.' S'�Y'P.�'t N.E. � 1 LECiAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED oESCa. 12 4 Horizon Heigl�ts sr+e�r 2 PROBERTY QWNER MAIL ADDRESS ZIP PHONE M'. H.. [+�e�ster 5251 k'il].more Street N. E. 3 CONTAltGTOR MAICADURESS ZIP PHONE UCENSE NO. T. M. Campion Co. 5435 Lyndale Avenue South A ARCHITEGTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO. 5 ENGtNEER MAJLRDRRESS ZIP PHONE LICENSE NO. 8 USE QF BUILDING Resid�tial 7 CLASS OF WOAK ❑ NEW � kDdITION ❑ ALTERATION � REPAIR 0 MOVE : CJ REMOVE 8 OESGR�BE WORK Construct a 14' x 20' Additi,on to dwelling _ 9 CHANGE OF tlSE FRObI TO STtPUL�kT10NS P��de �.C� Al�nt in hall. outs3de s3:eeping rooms. Provide 22" x 30" a.ttic aacess _ �I�� OC�i Ub'�� S�P�R1"E i=E�M13S RE(�lIREO F�R MVit�tl�, ��' �ECTA�C • GAS Etc. M�lT�, �l.UI�IB11� AN� S�iGl�, ��'VrRED gY tqVy SEPARA7E PERMITS AR� flEQUIi�iED FOR ELECTRICAL, PLUMBING;-NEATING, TYP� OF OONST. OCCUPANGY GRQUP OCCUPANCY LOAD VENTILATING OR AIR GdNU1TfONiNG. �j�jp� �'�'� ` THIS PERMIT BEC4bSES NUEL AND VOID IF WORK OR C4NSTflUCT10N Z�N�AtG :SQ. FT. CU. FT. AUTHOp1iED IS NOT'COMMfNCED WITHIN 60 DAYS, OR IF COMSTRUCTION = - : OR WOAK IS SUSRENOED OR ABANDONEO FOR A PERIOD,OF 120 DAYS AT �SO SC�OO ANY TIME';AfTEi� tNORK IS COMMENCEO. NOt DWIG. UNITS ' OFFSTREET PARKING. I HEREBY GERTIFY THRT 1 HAVE READ AND EXAMINED THIS ARPLIGATION 1 STALLS GARAGES - ANQ-1tMQW 7M€ SAtu{� TO BE TRWE AND CORRECT. ALL PROYISIONS OF LAWS yALUATION SUR7AX " AND OR�fNANCES GOVERNING THIS TYPE OF WORK Witl BE COMPLIED $'� � rj�$ . $3 .79 WITH 1MkETHER SPECIFIED HEREIN OR NOT. THE GRANTINfl pF A PERMIT DOES NOT PFESUM@ TO' G1VE AU:THORITY TO VIOLATE OR CANCEL THE pERW11T FEE SAC CHARGE PRQYFSIONS OF. ANY OTWER STATE OR LOCAL lAW REGULATING CON- $22 ��Q STRUC OR THE p RMANCE OF CONSTRUCTION. � PLAN CHECK FEE TOTAL FEE $5.6�; $31.79, SIGNATURE OF CON7RACTOR OR AUTNORI2ED AGENT � IDATEI 1NH.EN FI ��RER VALIDATED THIS IS YOU ?PER IT . . . . _ �. _ � .:� _ . _ � SiGNAfiURf�Of OWNEfi IIF OWNER BUILDERI IDATEI � y � gL66�,1 � �ATE � CITY OF FKIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERt�[I�� NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWPdER: f'7�J- � �j�%C� ,�S S'/`z-�. Address. � • ��'s� / �/llirlan� /1�� y��r ,d �pl N' , BUILDER: ✓. %yf . C�"7�►'�l�L �' Addres s : �y� � �v �.y��..� �{�. Tel. No.: � .� No .: f Z�� Str eet : �</%/y�DyE�' LOT: I� BLOCK: 7 ADDITION � � � -�,� /c�� CORIvER LOT: INSIDE LOT: � SLTBAGK: SIDEYARDS: Applicant attach to this form Ztao Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDINC To Be Used As: „�p � f � � ` �� _ Front: F � Depth: �� Height: Square Feet: �� Cubic Feet: ,��,��ja� . .%� Front: _____ Dep�n: Height: � Square Feet: Cubic Feet: Type of Construction: �/�� Estimated Cost: 7,�� Zb Be Completed: ��a�l/V�1 Alt. A Alt. B Proposed Driveway TAidth If New Opening Is Desired $ $ (SEE REVERSE SIDE OF SHEET) The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the iacts and representations stated in this application are true and correct. See reverse side addit'onal information. � �� t DATE : � %.� � S IGNATURE • ' ''� r � S�ipulations: . �) ��,rc�,',4 ,� C, CL2tl�.�� v� .�� P��u.�4 �� • .?.� P.�...�-.l,. �2 `'X 3a '` i9-rt�'c i¢e.�e.�ss, �. � � �� '��r f�`�/� z Z - y � G� �zs� .�G ��L�� /X ��1 �. ,%1 ��-- �" �% �y -� � w - � ��c,�^�� (s� . s : .� -� r� ,� :r :.2 �� i vIII L'�JIZ �9 t; ; i,; J, �i��-�S Cr , �_�: �-; � �. �r . a4� ,i� �. � � � � LAND �ISRYEYOR � � � � . � � � REGiSTERED UNOER�UW6 aF STi�TE Of MIhiVEiOTA � �� .� � � � . . . . . . . . .. . � . f. .. . . . . . . L.iCEJ+ISED BY � ORDINANCE 4F � �17Y a'7F HINi�iAPOL►i . . . . i .. . $ 3018 E.*ST SSTN STRE�T RA. 4-469t � � -�� =S � �urbcyot'� �ertificatt �i �=�-- -- - "' � � , .- � . _ . � r ._„ M f {{ : � � . � . � . . � � � - . � . . �"' = =( %` � �-- • ri � .' �"', !.` , � � i . . . . � . .. . . . . . . .. f: i l ,� E 1 • ' i A , �" t,, � r � ; ;� . . . . � . � ., . . ' � � � � . : (.`�� r .� � . . . ' . . � � .. . . . ` : . � . . � �. . � �r .� � -_._....__ ..._.....��_ ��__ � �1 . �� . � � . � � .. ' _ _ ��` ' � t \ t� � + . , c;. � - , ~`,� J j , Z tD `` � f r� --�—.�__ ____� , . ;: , � LJ� � � �7 !. � ;' ; � `. � , „ � t. 1 L� � T � � .i � ;' ,+ � � � � r r o �� _ � ! � .i� � �t'� ri� \ � `��, t'� � , �+ �i ' . '� i ��% �! �` �,`, � � � �` \n _� 1. . � ' 1 1 1 � i . . � � : � �''� � `� i\ 1�- '�'? � �i, , � ; � '�= � � � � i � � �-�.._ �t . �'`,�, j ' �. � '�' _ � � ., �� - , \ .,, \ - � r �� , ? . . .., ..�:_ , i � � ' i ' , ' �.� t �� { , �� ('� 't t .�—.— ---� ._._.___ _._._� _ � ---� � i { � S � � ; - ... .. . f ._ �.O . - ..._ .. . . .. . -` . . . . .. . .. \ � � . . . . � . � . � , � . . .. . . . � f . ` . . � . . ' . � � � . . . � � ( HERffBY CERTiFY THAT THY ABOVE IB A TRUE AND CORRECT PLAT OP A SURVEY Of �� - � �� ' � ►,+'�� ZG,�ZOC�f 4 . � � �� Horr3z�n Hiaghts r�}. + ('� , ^ ,} AS SliRV2YED 8Y ME THiS_"__:_._v'.Ln o __DAY 4P_-_.:��.'_.��.t�.l_....�.A.D _.__��!7_.__... .,,// . ./! . �' � . . . . ... . i . � i t � . �' � �/' . .� / , � , i .- : . ��; , i' �/`�: <' .. � �..,`- Si ;nto-----_ - --__ _,�. _t f _:.-- ...___ P. C. JA KSON, MINNESOTA RE�3�l�TR�7tOM. NO. 3� �n.. ' J� �rm � � � � � . � � � . . . � _ ... . . . . . .. ... .. �.__ . ... . � � ;r AGREEMENT ; �., k --�� ,� . �� I' __ ��2��Z�- ii/ � �� , owner of the property Iocated at S�� /1%/y��j� ��j /V � have no ob j ection to the City allowing the construction of a i2ppNj ��_T1�_ to be � located at c�2 �/ �'/ �J/Y1O2� S� .�ithout the required certificate of survey that the City ordinarily requires for all new construction. ��-0 �, �� , S' nature � ��`I�l O�,Leh�� -�r% �, Address �� Date � e �,., . , . ;:...:3. . . .� f- � w a t� z M � � w J N A Q t7 � �i.. 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V � N 0 � � � N � � C s tw � � m � N � 0 a a Q � 0 t 3 i '° a� � 3 � a� ° �� N L' co a c � � a a� � U C i fC . = a .� o° .n � , I�'. p'. �. � � o W c�6 � ti1 v C u- N O Z � � O C. 0 w � a 'p � c � v � Z +� L r � � � n- . _ THE BELOW MUST BE F{LLED IN WHEN REPIJ�CING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED • �Qll"Il�nl� �/Et�T* �/Ff�T G(�(`I`ECT(�R AND GOMBI ISTIC)N AIR VFRIFICATI�N -� When !� �n acin,� an eYictin,� f�ran __, the undersigned hereby venfies that the � venting has been examined and,is free from rust, dete�oration,-obstructions, and is securely suppprted and firestopped where reguired. . Yes No O The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and tem�ination. Yes �J No () ( The unde�signed also verifies that the replacement unit is a listed assembly and meets the current codes and manufacture�s specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. , The ��+�na _ome�,st�en a�r is sized and installed to meet the current codes and manufacturer's specifications. When required to i�+all a n_w .om6 �ation air� it will be sized and instailed to meet the current codes and manufacturers speciflcations. � When ir,��in0 a new ��entina�y�,i±�, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufaeturer's ., specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes� No ( ) Yes� No ( ) Yes � No ( ) Yes� No ( Yes�No ( ) A�eliance T�ne and Si7p/Cemmen ��ent and �/ent •onn _ctor Info ation Appliance #1 Type BTU Input Fan Assisted or Nat _��_ Appliance #2 Type BTU Input �� Fan Assisted or Nat /�,,�,__ Appliance #3 Type BTU Input ' Fan Assisted or Nat Total Appliances • Total Btu Input ].3t�1� 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 � 1 �► �- ..- HEATING CO: . -. �rJi��r�'; .� - �- _ _ CIIYOF FR[DLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287 April 13, 2004 Ms. Betty Webster 5251 Fillmore St NE Fridley, MN 55421 Re: Final Inspection at 5251 Fillmore St NE Contractor: Anderson Heating &. Air Conditioning Dear Ms. Webster: A mechanical permit was issued on October 6, 2003 to install a furnace at your address. According to the 1991 Uniform Mechanical Code a final inspection shall be conducted on the work authorized by this permit. As of this date the inspection has not been requested. The pemut fee that was paid covers the inspection to make sure the work was completed according to the Codes. We will keep your permit open for another 30 days and if we do not hear from you within this time to set up the inspection, we will mark the permit "no inspection called for by homeowner after notification and the permit will be expired. To set up the inspection or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. Sincerely, DA NSEN Build' Inspector DJ/mh Building BUILDING Permit No.: " � Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY 763-502-4977 FAX �� Er�sc'rrvE �-i-2oio DATE I C� YOUR E-MAIL ADDRESS I TG� Vv � S%� � D O�,�%C . M�' C.IS srrEnvn�ss 5251 1-'1LLM�rX�C— S7' l�%C— THIS APPLICANT IS: �OWNER OCON1'RACTOR PROPERTY OWNER/ x�: M I%'G�t V�/�Q�S %� � �N�rr Ann�ss: °I DG 1 I IoW /r�` U4N� crrY }��}l'1 SC.-Y STATE�z�� PHONE: � Z�� C1- � e ( oCi l� CONTRACTOR NpME: SUBMIT A COPY OF XOUR STATE LICENSE STATE LICENSE # E3� DATE AND CER1`IFICATE OF ADDRESS: CITY STATE_ZIP INSURANCE pHONE FAX PROPERTY TYPE I�SINGLE FAMQ.Y/NEW CONSTRUC7'[ON SIZE O TWO FANIILY/NEW CONSTRUCTION STORIFS_� PERNIIT TYPE Q�flTTi�N � GARAGFJSHED ❑ WI1�iDOWS O BASEMENT FIIVISH I�ROOF ❑ DRAIN TII,E ❑ DECK ❑ SIDING ❑ OTHER O SWA�IIrIING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADD1T[ON 4iMA[NTENANCE/REPAIR 0 REMODELING DESCRIBE WORK BEING DONE: �% � RO ti � SIZE OF II�iPROVEMIIVT � LENGTH WIDTH HEIGHT S FT R FI �FIOUSE ONLY NUMBER OF SQUARES �� ❑ HOUSE dt GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of suvctucal membas to be used PROPOSED HEIGHT: �IDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl p��t ADDTTIONS_ & PORCHES SUBMIT: ❑ Alum�num ❑ T� 1. Site Plaa/Survey showing the ezisting structures ❑ Otha ❑ Fa�ia and proposed projxt 2. Two sets of constnu;tion plaas WINDOVVS 3. EnergyCalculations IN EXLSTING OPENINGS OYes �No LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCR[BE SIZE OF MANUFAGTURE STICKER ON WINDOW. OPENING CHANGES 8c TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION. INCLUDING THE COST OF LABOR AND MATERIALS: CQTAL dOB VAL[ Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Pazk Fee Sewer Main Charge Total Due (USING THE 1997 U.B.0 FEE SCHEDULE) OCCttlANCY TYPE $ C�' I L`� See Back Page for Fee Schedule S 65% of Building Pernut Fee S .001 times the total job valuation S � .0005 x Permit Valuarion Minimum $.50 $ $5.00 (State Licensed Residential Contractors) $ $2100 pet SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$22=$ $ 5450 Conservation Plan Review $ Fee Deter�rrined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ Make checks wvable to: (�tv of Fridlev Attac TfitS IS AN APPLICATIOI3 FOR A PERNIIT NOT VALID UNTIL PItOCESSED I hereby apply for a building permit and I acknowledge that the information above is complebe and accurate; that the work will be in conforn�ance with the ordinances and codes of the City of Fridley and wit�► the Minnesota Construction Codes; that I understand this is not a pernut but only an appiication for a pernut and work is not to start without a pennit on site; that the work will be in accordance with the approved plan in the case o w whj�h_, approval of plans. SIGNATURE OF APPL[C � ii2'" l/ U(/ PRIIVT NAME�'1 � jC N iN 6(�i S I C— � nn� l �.� _ PLEASE NOTE:'3EPARATE PERMTfS ARE REQUIRED FOR