AF - 43575City of Fridley, Minn.
- BUILDING PE�T N� � 7� s��
Date:
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Owner: �F��;:� • �+a�`.� .,,�"�``_� !�'° Builder ..� ' °` '._.,�5:.�� �__._..� _
f�
Address _._.. __.� .�` �.—_ Address — —_..----- --
a LQ�ATI�1+1 p� BUILD9NG
1��. �` � '� � � i �`, �'. i` r�* ' Part � Lot ' �,f,� I
No. �.���_ Street �� .�... _� -�—
� ���
..
Lot __.�...�.__ Block _ � �....,� Addition or Sub- 'vision,�'���� �"�--�_u'� -��.-�`���� �f "
P /f �
Corner Lot __.._.V._._.._._ Inside Lot _��_ Setback —_ Sideyard ._ ��_�.�.;�_._
Sewer Elevat3on _._.._ �___._...—....._ Foundation IIevation
DESCRIPTION OF �UILDIiVG
To t, Used,g/�� � ,�,,, ;� ,,•� .�� ,.3
��':'� �' '�" • '�� Frant � ' Depth �' ��Height "�. Sq. F� ..�.�.='���`Cu. Ft . _ � : ��"'`'
�� � a�.�� �—
,�t Depth Height �.,.�... Sq. Ft � Cu. Ft _
,�, , .. t ,�'�� �a" " ,r '',rr^'� `
Tyge of Construction �c,,,,�.'_-�'"`- '� � � _ F�� Cost��..� � '� �–�To be Completed ..._
In consideration of the fssuance 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 provisions of
ordinances of the dty of Fridley.
• '�`
:�� �+ � :�
In conslderatioa of the payment of a fee of $�.� , 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 worl�nen, in all work
done in, around and upon safd building, or any part thereof, shall conform in all respects to the ordinances of
FrYdley, Minnespta regarding location, construction, alterxtioa, maintenance, _rePair and moving of �buildings
within the dty limits and �Chis pez�mit ma.y be revoked at any time upo� 'ola.tio�° of any of the provisions of said
oTdiIISIIC23. -"` _
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� •, � �„'°� ..+� .f ?� `. " � � -".''! _. .'�'! �
•�- � ». ..' BUildin8 InsPectOP
NOTICE:
This perroit does not eover f6e wnatrucHoe, inatallalloe fo� wGing, plumbing, gas 6eatieg, aewer er water. Be sure ro aee
ths Bulldla8 Inspee�ar for seperate pare�ifs for these Items.
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�iPPLICATIOV FOl@ BUILDING PERMIT
CiTY 0�' i�RID�EY, MiNNESOTA
Owner's Name �� ��� �`'��L � -a° Bu�.lder �-'• �. /F'`7��� �� � ���
- .— ,...�....
Address� Addrees /���/ �i�'-,e�c :�� ��E,
LOC�ITZUN OF HUITfDING
�To. Street �Part of Lot
� ��' �E�v q r°'G� c �t�� �/�',�'s�H �o
Lot •.�� 81ock � Addition or S�divis�.on r�
Cornar Lot inaide Lo� �� 3etback�3ide-Yard �—`�
SEVdEIi ELEVAT�ON �'OUNDATION ELEVATIOi�T
Applicant attach to this �orm Certi��cate o� Susvey oiE Lot a�c�
proposea building� location.
�o be used aso
�
DE�CI�IPTION OT� $UILDING
0
� ��
Sq • Ft • _�/ 7�s�� , .,, Cu • Ft ._ 2'�, � � o
Front______ Dep• �_ �3eight
Sq. Ft. Cue Ft.
Type o�E Construction_ Et-�-�Es�amated Cos� � �° °
To be Comp
,� / �.� . _ /
The undersigned he�ceby makes application �Eor a�ermit �or the work
harein specified, agree�.ng to do a11 work 3n stric� accordarice with
�he City of Fridloy D�d�.nances and ruliag o� the Departmeat of euild-
ings � and hereby declares that a11 the faefis and represea'r�tions
stated in this apg�lication are true and correct. �:
� � � v
nAS� � 1 � � szcn�� v�
, �
(Schedule o� �ee Costs can be �ound on the Reverse �icle).
�"', �"�
.. . . �
. �_--.
�i73LD�NG PERi�T F`EE SC�DUI�E
Sec�:ion 2. The Inspector of Sufidings shall, be�o�e 3ssuing any
pe�aii: io� the e�ec�3on of any bu�.lding or s�ructure, or �or any
add�.�ioa to any ox�.stjn� build�.ng or s�ructure, or �Eor an� alterations
o� repa�=s �o any exis�c�a�j build�nc,� or s�ruc�u�e, upon application
�hore cor, �equire �he pay�nent by the a�p�.icant £or such pe�nnit of
rees �o the ainount herein belova set �orth ancl in �che manner herein
pgovlded to wito
2.1. �or any auch p�sc�nit �or the erection o� any fire-proo:� building�
o�he�c than a garago, wa�cehouse, �actoxy or grain elevator, or �ox the
e:rec�ion or any f�ge-p�oo� addit3ora, �or similar occupar►cy, �to any
exis� �ing buildi.ng shall be a�t the ra�ce of $1.40 for each on� thousand
cubic �eet, or �rac�cion �hereof, ir� such cubical contenics.
2e2. For any such perm�.�t �or the erec�cion o� any firo-proof garage,
warehouse, �ac�tory or grain elevator, or �or tTne erect3on or ar�y f�.re�
psoo� ado�ition, ior si�.lar occupancy, �co any oxiating bu�l.ding shall
be at tl�e ra�e of $1.25 �or each one thousand cubic feet, classified
as '°�i�eprooi" by Sec�ion 502 oF the Minneapolis Building Code.
FTOZ7'SE S
2.3. For any such pe�m�.� for the erec�ion of
�.ag oi:har than a garage, warehouse, fac�ory or
�on-��.reproo� addiicion, £or siYailar occupancy,
PerYnit $1.00 �o�c each on� thousand cubic feet.
GaRAG�S
,
any non-f3reproo� build-
grair► elevator, or any
to any exis�ting bu�.lding .
2e4. For any such �e�mi� �or �ha erecfiion oi any aoa�-fireproo�
garage, warehouse, yac�o�y or g*-aa.n eZeva�or, or for the erection of
any non-�Eireproo�E ad�it3.on, ior sim.i.iaY occug�ancy, to any existing
building or ior each such building or additione Ninoty Cenics for each
one �,ousand eubic �eet or graction �hereoi, 3n the cubical coa�ents
�ereof wi�ch a minimwm oi $4,00 a �
�or �he pur�ose oc compu�ing fees fo�c building pegmi.ts the cubical con-
ten�s o� any builaing or addition �to a uni corm height throug�hou� 1oy
multiplying the grour�a area covered �rom a point six (6) �.nches Zoelow
'r.he cloor lino o� �he�basement or cellar �o the average height of the
upp�r sur�ace or �co 'che averag� heigh� of the roof surface of the mairi
ga:ble of a pitched roo�.
2_.5, For �epa3rs or alterations ta an existing structure, the fee
sha].1 be at the rate o� $3.00 per each Five Hundred Doliars ($500,00)
or �:actSon �hereo:� in �tha cos� o� al]. proposed worke
2_.6e 3n no case ahall th0 ree charged �or aay permit as set gorth in
Section 2 be less tl�a�n $4,Qp, ^
�. y � �
S ; �
HARVEY A. CARTWRIGHT
ANOKA COYNTY SURVEYS
NENN6PIN COUNTY SURVEYS
MINNEAPOLIB SURVEYB
8410 PALM STR@ET N.W.
SUNBET 4-7885
OWM�R
INDUBTRIAL - JUDICIAL
BUSlNE55 - TOPOGRAPHICAL
CITY LOT6 - PLATTING
��in Ter�zplin
F— -- _—
CARTWRtG�T & Ol�SON
LAND SURVEYORS
RLdIST6R80 UNDHR LAWO OF STAT6 OF ININN680TA
�.ICBNO60 BY ORDINANC6 OF CITY OF MINNEAPOLIB
326 PLYMOUTH BUILDING FEDERAL 6-8721
HENNEPIN AT SIXTH • MINNEAPOLIS 3. MINNESOTA
$►�rbepor'g �ertiftcatc
GOMBINfNG �THE RECORDS OF
J. E. HILL, CtYIL ENGINEffR
EBTABLIBN6D 18a6
C. F. SANDHOFF
CIVIL ENGINEER
ESTABLIBMED /B08
JAMES NELSON
$URVBYOR
ESTABLiBNEO tY82
METROPOLITAN LAND
SLRVEYORS. ESTABLI8ME0 �t+e+
/O �
_ __ _ _ _ __ _ __ _ _ ___ _ _. _ _ 1
_-_ :�
_ __ _ __ _�
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�',�����"�1i',� ���� s
I h�reb� cer�ify th<<t this is c.. trua � nca corr=:�ct re�r�s::nt��tion of � su._rvey o_�:
�ot ��, Blocic 2, C�- ra;:n�. i��lol�n�a G�.rlens
��s surveycd b� r�e tlzis 8th day oi l�TOV�r��ber, 1961.
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SIGNHO -
' G�$TWRIGHT wND OL90N
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IYS6 �u � s ��' � �� ! � �� � V f�(� I
HEAT LOSS CALCULATIONS �Q'�j � DEPARTMENT OF BUILDINGS .�• I
i
Weatherstrips A.S.H.V.E, Construction No. Insulation
Guide
Windo Door Reference Out. Wall Int. Wall Ceiling Roof F7oor Kiad How E
Y No No 19_
Fl.� Room � Length Width Height Fl.� Room Length Width ..;
Windows an Doors—Crackage and Area Windows and Doors—Crackage and Area
�Vfdth Helght No. ot Llneal f. Area Wldt6 Helght No. o[ Lineal it. Aeea
No. o[ pane of pane llghta of crack aq. ft. No. ot pane ot pane llghta - ot crack eq. tt.
�' �.4 d'.
Coef. Btu (
Infiltration �� �` Infiltration �i
r
Glass � � Glass .
Exp. wall Esp. wall � z�
Net exp. wall .,�� Net esp. wall
Int. wall Int. wall __
_
Ceiling � � �. � Ceiling �(
Floor � � °1. Floor t
1'otal Btu. Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. k. E.D.R. or sq. ins. W.A. Leader area
F7.� Room ( Length �/idth Height �,� t r �Room ( Length �2 Width
Win ows and Doors—Crackage and Area Windows and Doora—Crackage an Area
Wldth Helght No. of Llneat tt. Area Wldth HetBht Na. of Lineal Pt. Area
No._ o[ pane of pane Ilghte of crack e4. tt.
In6ltration � �
Glass � /2 Q
Exp. wall � j('
Net esp. wall Qr 8'� �
Int. wall
Ceiling �
Floor B1 /�
Total Btu. /a,
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl. Room � Length Width �j�feight
Windows an Doors—Crackage and Area
Wldth Helght No. ot Lineat ft. Area
No. of pane of pan llghta ot crack eq. ft.
o � sJ
F
Coef. Btu
Infiltration � �j a / '
c,ass 9 I`
�p. Wau �
Net eap. waU ('g
` Int. wall
Ceiling '�T/' /�
Floor / �
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
��
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's �' � > / r���C+ �
� f t��:Si � rI/�.1 /L� �
_-���
� ' � � ��-
Glass
Eap. wall
Net esp. �
int. Wau
Ceiling
Floor
�:
'��
Btu '
��
/�
r
�'i`�,�
�L-ir�
- - -- ---- - — - �
Required sq. k. E.D.R. or sq. ins. W.A. Leader area
Fl.� Room I Length Width Height
Win ows and Doora—Crackage and Area
Wtdth Height No. of Lineal ft. Area
No. of Dgne oL pane ttghte ot crack eQ. it.
�• p' •6
� s i ''ii" �c
�� � 2
Coef. Btu
Infiltration �„ �; � �"�
c�asg
Eap. wall � �(
Net exp. wall
Int. wall
Ceiling �'
Floor � ,
Total Btu.
J
t
�
ft. E.D.R. or sq. ins. WA. Leader area
L
��
'��. Ci�rene� .T, �a��o�
124i ��,re�e�r�� �.�r�.
��i�l�r, ���,�sxte����.
���r F�'� . T��.r� �ar� s
`i�i.� Citg► �f �'r�.�i�� 3.� enfvrc�.n�
t'�e C�.tq �nd ��*� ��ste of Rr'ir�cee�ot�. In
f�� c���aZa3�ti, t�i� �14�rd �d� � s�vgy �f
f�llo���.azg eoad3.t�.c�as t,�e:ce u�n�e� wriic� �ar�
s�� in�rov�e��.
�`'8rC1'i 18, 19G%
t�� �e�lt� l�ws of
thi� c�nneetion �nd
�r�vr �r�n�.�e� and t�a�
in n�ee� s�f cc�rr�et ior�
Gasba�� �ci debr�� c�es� li�teracl �rc�u�d tt�e �arbage can�
artd tra�?� burn�r, T2�is i� n�� on�,y un�i��tly, but magr �r��ide
exeelL�a�t ?��rb����e fnr r�den�s �nd c�th:�r ver��.a�. �18. �arba�e
si�a�.I be c�s�3�e+d, s�r��p�d c�ad �r4pelcip �t�►red i� tightly Cr�vereci
��tal c���t�.inr�rs u�atiZ c�11e�c��. �a�ri��e :�hail he c�'1lectec? at
L��.st or�ce a��ek. �E�e t�u�in$ of garb��e �.rl the citq �►f �'ric�ley
i� �rc�hib�.�C�ci. �iCy 1�� r�qu�.reffi t°��t ,�arba,ge �r�d refuse can� 'be
�tc3red �.n ��� ��ars�e or �n► �o rear of t�e pr�a�i�e� �.n a xack�
el�v�tin� t�c� raa�� at le��t 1��� abc�ve ��.e �,zAVnd sur�aca.
T�E �����e ec�a�d�,t�4n� �se �c�t corrected by ����rc1� 2S, i9�7,
��i� �Aarc� ta�i11 �±ave n� �1na��.oe bu�t tc� c�.use eaid nu3.�ance �e� be
ai�a�e�S .�,�e Z���+e, �lC1�•rE�qBL" � t�.�t c�uth �.��ien �a�.1L bc� wr�teee���zy'
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SuBJFCT
c�ty of Fridley
AT THE TOP Of THE TWINS g � I L D I N G P E R M i T
�
S �
� ; y __��� COMMUNITY DEVELOPM�NT DIV.
r � � PROTECTIVE INSPECTION SEC.
� . ,
� Z �"'1 � CITY NALI FRIOLE� SS�32 NuMBEp pEv
�"""'� � �'' 612-571-34b0 s�aF�S
,oe nooaess 1247 Gardena Avenue NE
1 LEGAL LOT NO. BIOCK � TFiACT OR ADOITION
DESCii. rj 2 Gardena Meloland G
2 PROPERTY OWNEFi MAIL ADpR�$$
Patty Scott
3 CONTRACTOR MAIL AODRESS
Midwest Cedar Timberoof 1001 E Cliff Rd. Burn
d ApCHITECT OR OESIGNER MAI ADDRESS
5 ENGINEER MAIL ADOfiES3
8 USE OF BUILDING
Residential
7 CLASS OF WORK
8 DESCRIBE WORK
Reroof hous
O�TE
9/23/99
ZIP
PAGE OR
/ /
�RMIT NO.
302�8�
ECEI� O.
�� �
vppvEO Br
SEE ATTACMED
SFIEET
PNONE
571-8928
PMONE LICENSE NO
8-1149 20147336
PFIONE LICENSE NO
PFIONE LICENSE NO
� NEW O ADOITION O ALTERATION 1S8 REPAIR p MOVE O FiEMOVE
9 CHAN(3E OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
[��rmit Inspec��Qn ��r�s
WIII ge Mall�d �
To Homeo�rner To Po��
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAI, PLUMBING. HEATING. �'r� v. w••�.
VENTI�ATING OR AIF CONOITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK Oii CONSTRUCTION ZONING
AUTMORIZED IS NOT COMMENCED V�IITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO POR A PERIQD OF 120 DAYS A7
ANY 71ME AfTEF WORK IS COMMENCED. NO DWLG. UNITS
I HEFiEBY CERTIFV 7NAT I MAVE READ AND EXAMINEO THIS APPLICA710N
AND KNOW TME SAME TO BE TAUE ANO CORREC7. ALL PROVISIONS OF LAW$ yp�UATION
ANO ORDINANCES GOVEqNING TMIS TYPE Of WORK WI�L qE COMPlIEO
WITN WHETHER SPECIFIED HEREIN OR NOT. TME GRANTING Of A PERMIT ��.66�.
DOES NOT PRESUME TO GIVE AUTHOFiITV TO VIOIATE OR CANCEL T►iE pERM17fEE
PROVISIONS OF ANV OTNER STATE OR �OCAL LAW REGULATING CON-
STRUCTION OR TME PERfORMANCE OF CONSTRUCTION .�GO. �.O
PLAN CHECK FEE
Licens C
S�GN4TUAE O� CON'AACTOp Op 4UTMOQ�ZED OGENT iO�TEi EN P(
S�GNniUFE O� OWNEAa� OWNEpBU4DERi ip�1Ei e� n....en �
OCCUPA
STA��S
�
OCCUPANCVLOAD
CU FT
' PARKING
GARAGES
�.8�
SAC CNARGE
Fir SC $1.66
TOT EE
$ .59
° � � N�w [ `� - Effective 5/10/99 ��
ADDN [ l CITY OF FRIDLEY nb� �_��j�I
ALTER �J SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2 'i� ��
BUII,DING PERNIIT APPLICATION � ��
U" d
Construction Address: � ��� ��UfQ�� � ��, � � � � �
Legal Description:
Owner Name & Address: �j �' r�}-� (�'� �{' ���s . (� �, Tel. # � p ��- 'rj' � �- ��Z �
Contractor. ��(..�j-° CPr( c� fil�ar C�G� _MN LICENSE # Z� ��} 1��
Address: _�(�(�I �, Gi �� Rd. Te1. #(:o IZ- ��— I 1`iq
Attach to this application, a Certificate of Survey :of the
lot, with the proposed construcdon dra�vn on it to scale.: ..: _
LIVING AREA:
GA.1?.AGE AREA:
DECK AREA:
Length
Length
Length
�ESCItT�TION �F �'RO .�1�1'A' "" `-. . ; . _
Width Height Sq. Ft.
Width I3eight Sq. Ft.
Width Hgt/Ground Sq. Ft.
01'HER:
I q �'S �
Construction Type: Estimated Cost: $_ '�j ��(Q, lp� ��(. �Dl` I
Driveway C�rb Cut Width N�eded: Ft. + 6 Ft = Ft x$ _$ .
DATE: e`1 APPLICANT: (1�, �,, ��� Tel. #(� � Z�� - � ��°f
� U
Permit Fee
Fire Surcharge
Sta.te Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sew�r Main Charge
TOTAL
STIPULATIONS:
� I� .�
$ � � ��P
$ .�
$
$ �• �
$
$
$
$
$ � � ��
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed 1�esidential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
1 �� /r ,
�� ` �
! _� a `
BUII..DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing �rmits 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 theref�r�; rec}u.ire.: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
$1 to $500
$501 to $2,000
$2,OU1 to $25,QQU
$25,001 to $SO,Q00
$50,001 to $100,000
,
$100,Q01 to $500,000
$500,001 to $1,0�,000
$1,000,001 and up
FEES
$23.50.
$23.50 for first $500 plus $3.OS for each additional $100 or
fraction thereof, to and including $2,000
$�9.25 f.or fir�t $?_,(_N10 �lus $14.CKJ for ea�h additio�al$1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,0{� plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 %r .first $100,000 plus $5.60 for each addiuonal
$1,Q�(R3 or fraction thereof, to and including $SG0,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1, 000 or fraction thereof, to and including $1, 000, 000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1, 000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets flnly)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alteriate "B": Removal-and; replacement_ of :curb and �utter aud �stall a 3%ot wide -
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow �or proper
review of the proposed structure and of the construction site.
� A Certificate of 5urvey of the lot, showang the location of the foundation once it has it has been co�truct�d �aiLri
be required before proceeding with the framing.
sue�Etr � PEA,AAJ�I_ .
City of Fridley ��
AT TME TOP OF TME TWINS g � I L D I N G P E R M I T 3 2118
r
! �` COMMUNITY OEVELOPMENT DIY. �����,6�4 R ,���
r � v � PROTECTIVE INSPECTION SEC.
i . ,
l--_. A��'�'�•� CITY FIALL FRIOLE� 55132 NUMBEN REV OATE VAGE Of A VROVEO BY
t �� 612-571-3450 9t0-F15 8/28/O1 / /
JOB ADORESS 1247 Gardena Avenue
1 LEGAL �OT NO. BLOCK TFACT OR ADOITION SEE ATTACMEO
DESCR. 5 2 Gardena Meloland Gardens SFIEET
2 PROPERTY OWNER MAIL AODRES$ ZIP PMONE
Patty Scott, 1247 Gardena Avenue, Fridle , MN 55432
3 CONTRACTOR MAIL ADDRESS Z�P PHONE IICENSE NO
D.J.'s Remodelin , 11207 Ma nolia St. NW Coon Ra ids, MN 55448 763-5%$757-8521
a ARCNITECT Oii OESIGNER MAIL AODRESS ZIP PMONE LICENSE NO.
20053769
5 ENGINEER MAII ADDpE33 21P PMONE LICENSE NO
8 USE OF BUIIDING
Residential
7 CIASS OF WORK
� NEW ❑ ADD�TION O ALTERATION p REPAIR O MOVE O FiEMOVE
8 DESCRIBE WOiiK
Reside
9 CHANGEOFUSEFROM TO
STIPU�ATIONS
Per Section 1402, 1997 Uniform Building Code requires that a weather resistive
barrier be placed over exterior sheathing to protect the interior wall covering.
Exceptions for this provision would be if sheathing is an approved weath�rproof
panel or when the siding 3s an approved weather barrier. Vinyl siding is not a
weatherproof covering unless the manufacturer states this in the application
guidelines. Call for inspection of wrap before covering.
SEPARATE PERMITS ARE FiE0U1RED FOR ELECTRICAL, PLUMBING. HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV �OAD
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SO. fT CU FT.
AUTMOqIZED IS NOT COMMENCE� V�IITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONEO FOR A PERI00 OF 120 DAYS AT
ANY TIME AFTEfi WORK IS COMMENCED NO DWLG. UNITS OFFSTREET PARNING
I HEREBY CEiiTIFV THAT I HAVE READ ANO EXAM�NEO THIS APPLICA710N STALLS GARAGES
AND KNOW TME SAME TO BE TRUE AND CORREC7. ALl PFOVISIONS OF LAWS VALUATION SUR7AX
AND ORDINANCES GOVERNING TMIS TYPE OF WORK WILL BE COMP�IED
WITH WMETHER SPECIFIEO MEREIN OR NOT. TNE GRANTING OF A PERMIT ��1�000.00 �Z.00
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL THE pERMIT fEE SAC CMARGE
PROVISIONS Of ANY OTHER STATE Ofi LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $9%.25 Fire SC ��F.00
PLAN CNECK FEE TOTAL FEE
Li nse 5.00 $108.25
S�GNGTUpE OF CON'AACTOp ON AUTHONi2E0 OGENi iO�iE� HEN ROPEpLY VALIDAIEO TMIS IS YOUR PERMIT
S�GNnTUAE Oi OWNEA��� OWNEA BU4DEpi �O�T6� � G"�NS ph
NEw [J
ADDN [] ,
ALTER [ ]
Construction Address: / �i7
Legal Description:
Owner Name & Address: �
7 ,
Contractor: � , s ��
Address: / /��1 � v�-rr�-��
LNING AREA:
GARAGE AREA:
Effective 1/12001
CITY OF FRIDLEY (763) 572�604 Bidg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
MN LICENSE #
# Rt �0 3- �S'7- �S�/
�D ��Q
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq. Ft
DECK AREA: Length
OTHER:
Width Hgt/Ground Sq. Ft.
Construction Type:_��2�� Estimated Cost: $ y��l�, %
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
,-,�..�
DATE: 4 ��O � � % APPLICA(�T: � � Tel. #7� � � 75 �7 ��5 � I
�,.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$ .�,sl Fee Schedule on Reverse Side
$ • Oa .001 of Permit Valuation (1/10th%)
$ � � $.50/$1,000 Valuation
$ $1150 per SAC Unit
$ �dU $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "6" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ /oS.� _
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addidon 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
$1 to $500
$501 to $2,000
$2,001 to $25,0�
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $SOU,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3 .OS for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,0�
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, tc, and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,(�0 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway widtli plus 6 feet times $15.50.
Alternate "B" : Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
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
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COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When repiacing an existin� furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deteriorataon, obstructions,
and is securely supported and firestopped where required. Yes () No ()
The venting system is piastiGPVC and meets all cuRent codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the cuRent codes and manufacturers specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existinsa combustion air is sized and installed to meet the cuRent codes
and manufacturers specifications.
When required to install a new combustion air, it will be sized and instalied
to meet the cuRent codes and manufacturer's specifications.
Yes ( ) No ( )
Yes ( ) No ( )
Yes()No()
When installing a new ventin� svstem, the undersigned hereby verifies that
it is a listed assembly and meets the cu�rent codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliance�. 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 ConnecYar Information
Appliance #1 Type BTU Input ' Fan Assisted or Nat _
Appliance #2 Type BTU Input _ Fan Assisted or Nat _
Appliance #3 Type BTU Input Fan Assisted or Nat _
Total Appliances Total Btu Input
Common Vent Type Vent Height � Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in i ype
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS• (Describe) -
�OYALi(7N MEATING & COOLING
4120 - 85th AVENUE NORTH
HEATING CO:��,�LyN �A�K.�N 55443 —
Signed By: 763'�424-�333 Date : �–.f5°�2-
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C['iYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
April 20, 2004
Ms. Patty Scott
1247 Gardena Ave NE
Fridley, MN 55432
Re: Final Inspection at 1247 Gardena Ave NE
Contractor: Gavic & Sons Plumbing
Dear Ms. Scott:
A plumbing permit was issued on March 6, 2003 to install a water heater at your address.
According to Section 4715.2800 of the State Plumbing 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 permit 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 notifica.tion" and take no further action.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
Sincerely,
DJ/mh
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763-424-�333
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-�-__�_._._.
Ceiling
-..r....-..._._�.
Nloor
—_...�.r
TotsJ &u.
..r�. a.�ea aroe�
��
aad Area
fe. E.DR or �q. iw. W.A L�eader arei►
Rooa� �l.eo�th Widti:
and Door+---Csuksse Rad Area
pEPABTMENT OF iNSPEC?!ON
; c� N0.
i� W.li CeiIi�a� Roof �-loot
aii�
2.%�
�
Bto
C�o
Fs�►. '..�
��
Iat. waQ
'a�al �t.
�e�iID'� aq. �4. �4�. 08 i�, iro6.
F7.� i�oom � (�
Wmdo►rs a�ad Doo�s�-.Cau1�
Clsa
�P•'
N�c �
� M
bCa1ld
tal8tu.
� w• fe. �D.[�t or �q. m..
R�oon� ( La�st�
Wmdo� �od Dbo��—�Crulra,�
�:ia�1t
Esp. �+s1)
IVet ccp. wall
�b �
M
11+ID�II�A
.... �.
..-- �
Width
aad Ace�►
are.
�r .o. .ea. w�►. a�.ae� .�ea �
TOTAL P.04
:�
�
, _.
.'
�+ M
HOUSE HEATING TEST RECORD
ADDRESS l i� f C "'� r `F�� �,��n `5;� d°°, �•� �a �,� �� G ' '�,t' . ,
=� ��,. � �. �...�—APT. FLOOR CITY 7�R. �� - '�'°SUBURB___,
QCCUPANT _� � a° � P. , e� ! s,�,r `�- 01MNER —�
HEAT LOSS DATE HTG. INST.
SOLD BY INSTALLED BY
El�chicol Work' Br Gas Lin� Br
TYPE OF HEAT GA FA,��H1M STEAM SPACE HTR. UNIT HTR. OTHER
MAKE ���`-���{ ' ( GAS DESIGN CONVERSION
AAAKE OF BURNER
Mod•I �'�� � �' _ ��` !'"! �� �' �+ s ,° � IAod•I
S«iol � ��- � � �•' � `� �. Max. BTU Ratino
INPUT � ri�; ,����n������'� MAKE OF FURNACE
Mod�l
-� � CONTROLS � �, �,��
THERMOSTA�T {� --�' H�at Pluy r' �-�' V�nt Sizf�'
VO�"• ���`� �" �, � KIND OF LINER � SIZE � d
�Limit � o � ��"' � ' NONE
�� �MT. �.� D.ah Hood p 9 Rpulowr
Limit S�ttiny �'�'�� �'` Fllhrs Si:� "'�� ��� umb�► °
Fan Ssttinp � Chimn�r Loeafion Insid�. OW�id�
Pilor TrP.�° "�`.�'�` Q�imn�y Construefio� � �..�� �h
Pilot Maks
Pilot Modsl Snnok� Bomb -- Wirino --�y���
Pilot Timing Draft e�� '°` �_ P`°/�
+`�y.�� T�st Too
L.W. Cut Off Door Pnssur�
Liqh�inq Inst.
� �� �,r e � •
Pnssuro �—' � -� P�re�nt C0� °-°j �" Dot� T�st�d �a -' '� � t �
�
I�ut CFH �P�►e�nt 0 �� ° � '�`" � � 3'�"-----
Stack T�m `"�''� / F.i� 2 � C°mponr T�sting � + � " ( �":�•r_� -i�,.:-� f a �
P• —�,,a--.a P�rc�nt CO �� Nann ef T�stn � � � �` �' � °
Fwm 235 ...A-° °� �` "'���