AF - 45251City of Fridley, Minn.
BUILDING PERMIT
� �Oa'a �
N° '7298
• Da�: -.�.� -._ � ��_ _. _..�_
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Owner: ��j��'__ __ Bwlder ..... :._ _..._...._.�r_
Address
Address
No. ��,�I��Street
TION
Lot _..._....__.__..._....__ Block _.___._........._......_._.._..._....._. Addition or Sub-Division�-•�,ar.��f���•--�
Corner Lot __ L� Inside Lot ._...�..---......._._.___......_... Setback _..�• .............. Sideyard ._.... .�i..�.._....._...._......._......_..._...._.._
�c� �i �
�V1./f.Sewer Elevation _.�..�.�.�v'_...��...�T___.._._.__.._.____.._......_..__......_�en Elevation ....._.0....� .�.�._5....f�.:._._.__..___.__..._._.
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DESCRIPTION OF BUILDING
�
_�;Q.0 Depth ..�,.�:Q_. Height ��._.. Sq. FL����Cu. F�..�l�
_�__._____......__._..._....._. t__.__...___ Depth _..._. Height .___...�.� Sq. F� .___.___...._.. Cu. F� ._.._._�_
Zj�pe of Constru ..._.. __.�_.....__.. Es� st ��,�d�._�To be Completed _..._.......___......_...__......_.__
In cansideration of the issuance to me of a permit to construct building described above, I agree to do
the proposed work in accordance with the descriptiou abave set f and in com ' ce with pro�visio
ordinanoes of the city of Frfdley.
Ea carrsideration of the payment of a fee of ��...._......_.., permit is hereby grauted to__.._._._._ ..._
... to construct the building or addition as descrlbed above. This permit is granted upon
the expree�ss condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, sround and upon said building, or any part thereof, shall conform in all respects to the ordinances o�
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
�� dty limits and this permit may be revoked at sr�y� t� viola^on of any of the provisio�ns of said
/ !/1
Building Inspector
NOTICE:
ild� p�rmil dea net �ewr 11w eosMroeNoe. in�hllatien fe� wi�iao. Plw�bhiW Ya hwNn�, anw�r er waN►. B� wn to sM
fh� Buildina In�paior for s�p�ralr p�nnits for fhu� itNn�.
��
:�
� sue�e�r � � � P �NO. ,
c;ty of Fr�a�ey � � 28761���
AT TME TOP OF TME TWINS ������ N� P E R M I T
� - 572-3604 4�
� �`V ����� COMMUNITY DEVELOPMENT DIV. RECEIP��
r � � PROTECTIVE INSPECTION SEC. J
� . ,
� � �"'1 � CITV NALL fRIOLE� SS132 NUMBER REV O�TE P�GE OF •nvnOVED 8�
�._--�•' ,•' 612-571-3450 9t0-F15 � �
12/15/98
�oe nooaess & ,5 57
5355 Fil more Street NE
t LEWI ��uD�d. lO BlOCK TRACTORAODITION SEEAT7ACHED
OESCR. Pt. 7 Auditor's $Ub. NO. 9�} SHEET
2 PROPERTY OWNER MAI� ADORESS 21P PMONE
Mar Shields 1-8039
3 CON7qACTOR MAIL ADORESS Z�P PHONE LICENSE NO
Nutzmann Bros. Const. 736 lst Ave NW N
1 ARCHITECT OR DESIGNEfi MAI� ADDRESS 21P PHONE LICENSE NO.
5 ENGINEER MAIL ADDFiESS ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION 0 ALTERATIAN � REPAIR O MOVE O REMOVE
B DESCRIBE WORK
Reroof double bun alow (27 S) Tear-off
9 CHANGEOfUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYP OFCONST OCCUPANCVGROUP OCCUPANCV�OAD
SEPARATE PERMITS ARE REOUIFEO FOR EIECTRICAL. PLUMBING. MEATING,
VENTILATING OR Alp CONDITIONING
THiS PERMIT BECOMES NULL AND VOIO IF WORK OR CONS7WUCTION ZONING S�. fT CU FT.
AUTHOR12ED IS NOT COMMENCED WtTHIN 60 DAYS. OR if CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 12p OAVS AT
ANV TIME AFTER WORK IS COMMENCED, NO �WIG. UNITS OFFSTREET PARKING
I HEAEBY CERTIFV THAT I MAVE AEAD AND EXAMINEO THIS APPLICATION STA�LS GARAGES
ANO KNOW THE SAME TO BE TRUE ANO CORRECi. ALL PROVISIpNS OF LAWS yq�UAT10N SURTAX
ANO ORDINANCES GOVERNING THIS TVPE OF WORK WI�L BE COMPl1ED
WITM WMETHER SPEGFIED MEREIN OR NOT THE GRANTING OF A PERMIT 2313 l. IE)
OOES NOT PRESUME TO GtVE AUTMORITY TO VIOLATE OR CANCEL TNE PEqMIT fEE SAC CHARGE
PROVISIONS Of ANY OTHER STATE OR LOCAL LAW REGUTATING CON•
STRUCTI pR TM PERFpRMA CE OF CONSTRUCTION F1T2 SC 2. 1
^ PLAN CHECK fEE TOTA� FEE
S�GN1iUAEOFCON'AACTQ RAUTMOQ�ZE04GEN1 iD�TE� WHEN PiiOPERLY VA ATED TNIS IS? OUR P RMI
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$�GN47UAE 0% OWNEA��� OwHEA Bui�OERi �DATE� � � g�p O� � r��i
N� � � ]
ADDN [ ]
ALTER [ ]
ConstructionAddress :
Legal Description:
Owner Name & A
Contractor: �
Address: 73(0 7�
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
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Effective 1/1/98
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Tel. # �%/-U�9
_MN LICENSE # 2C�''����
Z Tel. # ���lo�-C�l��
Attach to this appli�'ation, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IM�'ROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
Sq. Ft. _
Sq. Ft.
Sq. Ft.
� �
Construction Type: ` Estimated Cost: $ � �
(Fee Schedule on ack)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ =$•
�
DATE: � APPLICANT: L�OC� Tel. #� z FS- d%Z�
CITY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ •� �
$ •3�
$ f•/�
$
$ S�.Oc�
$
$
$
$
� 3�22
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1000 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ J Not Necessary []
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COMMON VENT VENT CONNECTOR AND COMBUSTION AlR VERlFICATION
When ret�lacina an existina furance, the undersigned hereby verifies that the
venting haspbeen examined and is free from rust, deterioration, obst�uctions,
and is securely supported and firestopped where required. Yes �% No ()
The venting system is plastic/PVC and meets all cur�ent codes and manufacturer
specifications including sizing, length, number of elbows and terminatian. Yes� No (}
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances.
The existina combustion air is sized and installed to meet the cu�rent codes
and manufacturer's specifications.
Yes� No ( )
Yes ( ) No ( )
___ __ _ - — - - - .
. ____ _
___ _ __ __ _ _ _ _
- Wi�en required to install a new combustion air it will be sized and installed
To meet the current codes and manufacturers specifications. Yes � No ()
When-installinp a new venting system, the undersigned hereby verifies that
= it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes � No ()
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 ()
/�
Appliance Tvpe and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type STU lnput Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type Vent Height Diameter inches
ApRlia�#�-�eflt-Eanrre�t�r i�t�1�i _fif _ Lengf h_ : ft
Appliance #2 Vent Connector Height ft Length ft
Appliance #3 Vent Connector Height ft Length ft
ALTERATIONS: (Describel
Diameter � in Type
Diameter in Type
Diameter in Type
I�i-P ;� �i �� . � �..�� �..�� s �� (' �1' � � ^ �� � ct �C� .
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HEATING CO: ,
Signed By: Date : � i+ 2�U l
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