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AF - 45191�, Da�; APRIL 27, 1966 �r: STANTON' BERG City of Fridley, Minn.. BUILDING PERMIT �� 3� �� 1V'° 8796 B�� S. E. TEMFI,IlV CON�ANY �� A� 1251 Gardena Avenue N. E. Fr3dley, Minnesota 55421 LOCATION OF BUILDING No. 6025 g�t Gardena Lane N. E, p� of Lot Lot 3 Slock � Adciiti� or 3ub-Divdeion Gardena Meloland Gardens Corner Lot _ x Inslde Lot 35 � Setback ffi 35' Sideyard 10' and 10' 8ewer IIevattam 916.33 IIevation 919 33 TO'p OR FpOTT1QC DESCRIPTION OF BUILDING To be Used ea: DWII,LSNG �t 42 �p� 29 H��t 20 �. � 1, 218 ��.,� 24, 360 A7T. GARAGE �t 19 2 Depth 24 ��q�t 10 �. � 468 �� 4, 680 Zj►pe oP Constructlon FRL�'ME �, �$20, 000 _ To be Completed SEWER - 88' N.W. of Maahole WATER - 78' N.W. of Ma.nhole COUNCIL ACTION - at Intersection Gardena Lane and Gardena Circle In co�lderation oP the 9ssuance to me of a permit to c ct the b�i1din� described above I agree to do the proposed work fn accordance with the des�iption above Porth a� in comp�nce with afl proviafons oP or8lnaaces oP the dty oP Frldley. ,� // /'� �, In camafderatton oP the payment of a fee of y 30. OU , permit fs herebY granted to S. E. TEMPLIN CON'STRIIG°rION C0. ta �� ,� bufl�Ifng or addition as descrYbed above. Thfs t is grauted upon the ezpress condition that the pereon to whom it ia grented arcd hia agenta employees an worl�en, 9n all work done in, eround and upon eaid build9ng, or anypart thereoP, st�all conPorm in all respecta to the orciinanceg oP Fridley� Minnesota regardii la:ation, camatruction, alterafilon� mafntensace� repair and moving oE bufldfuga wi�� dty ]imfts and � permit may be revoked at any �dme upon viola�lon of aay of the Provieions oE safd ALLEN G. JERSEN ��8 �� NOflC� 'flds p�emft doa �t eowr t6� eeesfeuaHm, tmta� h� rrieie�, piumbteo, ea 6talte�, a�ra ee watu. B� wn �o a� tia Botldiny les�lor hr apaeat� p�emtb for t6a� N�. , : OWNER'S ADDRESS I� / , 7 f. J yi '��. I APP`LICATION FOR BUILDITTG PERMLT C OF FRIDLE°Y, MII4NESOTA �=�" � ' _ .� ��w��+� BUILDER � • � � ( a. �'T'T� �,nD�ss /'� ,1 / �, �-�— �� LOC �ON OF BIIILDING � N0, �� STREET �� • pART OF LOT LO� - BLOCK � ADDITION OR SUBDIViSION �G�� a� ��,�� CORNER LOT INSIDE LOT SETBAGR �� SIDE-YARD �� '` /�� _ - . SEWER ELEVATION �� . �� N ELEVATIUN a /�/�� . -� Applicant attach to this form Two Certificat�o��Survey of Lot and proposed building locat3o�n d�r wn on theae Certificates. � -- � � ' � �' � � - �� az— �L . ;�? , � �-�. � , G� � % � �DESCRIP't'lO�OF B`u�n�RG To be u as ; �� ''"�=� Front"7��Depth,�Height � � � Sq. Ft. Cu. Ft. - Front / � Depth �Height� ./�� R '��d"T__ j' , Sq. Ft•---,��—��—Cu. Ft. � �~ Type of Construction � Estimated Cost �,.� w ��_y To be completed The undereigned hereby makea application for a germit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Degartment of Buildin,gs, and hereby declares that all the facts and representations stated in this application are true and correct. DATE � `��"`,`�-� � I�IGNATURE � � ��r �`+- (Scheduie of Fee Coets can be found on the Reversa Side). �� - �, �•.1 � �� n .��3 e ,� 6� � � � �� BUILDING PE1iMIT FEE SCHEDULE SECTION 2. The Inapector of Build3ngs sha11, before isauing any permit for the erection of any building or etructure, or for any addition to any existing building or structure, or for any alterations or repairs to any existin� building or atructure, upon application therefore, require the pgyment by the applicant for,such pQrmit of teee eo the �ount herein below set forth and in the manner herein provided to-wit; , 2 1_ For any such permit for the erection of any fire-proof building, othei than a garage, warehouse, factory or grain elevaCor, or for the erection of any fire-proof addition, for aimilar occupancy, to any esieting building,° s1�a11 be.at the r�te o£ $1.40 for each one thousand cubic feeC,.or.fraction thereof, in such cubical�contents. .. � 2.2 " For aay such permit for the��erection of aay fire-proof garage, warehouse, factory or �rain elevator, ar for the+erection of any fire•proof additian, for similar occupancy, to any exieting building sha11 be at the rate of $1.25 for each onr� thousand cubic feet, clasaified as "fireproof" by Section 502 of the Minneapolie Buildiag Code. . flOIISES 2.3. For any such permi� for Che erection of aay non-�ireproof building, other than a garage, warehouse, factary or graia eZevator, or any aon-fireproof addition, for similar occupancy, to any esisting bui,lding - permit $1.00 for each one thousand cubic feet. GARAGES 2.4. For any such permit for the erection of aay non-fireproof garage, warehouse, factorq or grain elevator, or for the erection of any noa-fire-proof addition, for aimilar occupancy, to any egisting building or for each such building or addition - niaeCp cents ($0.90) for each one thous.and cubic feet or fraction thereof, in the cub�.cal contante thereof with the minimum o£ $4.00. For the purpose of c�rputing fees for building permits, the cubical contents of any building or additioa to a uniform height throughout by multiplqing Che ground area covcred-fram a point� six (6) inches below the floor lfne of the basement or cellar to the average hr�3ght of the upper aurface or �o the average height of the roof surface of the main gable of a pitched roof. 2,5. For repairs or alterations to an existing atructure, the fee shall be at the rate of $3.00 per each Five Sundred Dollars. ($500.00) or fr�c;.ivn , thereof in the cost of a11 proposed work:' 2.6. in no case shall the fee charged for any permit as set forth in Section 2 be less than $4.00. ° STORM REPAIR DAMAGE FEES: Residential: Eatimated Cost of work up to �yfn,f�4 -$5.^� Estimated Coat of wor'�. c°:rr �:z�_..-a.� - Y::,-,f�0 `�om�ie`i'cial; Estimate�Cost o:� �onw•;�: �t;�t� ° `.•:��sv�� a'��0 ¢ � , �� Estimate ;'o�� of ��ox� ovcr �;i��;.�U - $� s0 . a . a HARVEY A. CARTWRIGHT ANOKA COUNTY BURVEYS K[NNEPIN GOUNTY SURVEYS MINNEAPOLI6 SURVEYS Bd10 PAIM STREHT N.W. $UNSET 4-7865 owNEa INDUBTRIAL — JUDICIAL BUBINESS — TOPOGpAPHICAL CITY LOTB — PLATTINfi S�m ^lennlin � �� D �� G� �`� � @J � � �� '� � � �� LA1`YD S�I�t �%EYOdtS RE618TBRCD UND6R LAWO OP STAT6 OF MINNE80TA LIGi'iNG60 BY OROIMANCQ 01r CITY OF MINNEAPOLIS 32B PLYMOUTH BUILDING FEDHRAL 8-B721 HENNEPIN AT SIXTM • MINNEAPOLI3 3. MINNESOTA �arbepor'g,` ertii�catc � V� 1 ♦ I � �`� .�. ,r� ! l I .. r �- � •r d i � �-�� , „� -.- � � W ��-... � ,` w � r e \ r ,1 � COMBININ(: TME RECORDS OF J. E. HILL, Crv�� ENOINE6R [9TABLIBM6D tOY6 C. F. SANDHOFF GIVIL ENGINEER EBTABLIBMED 1Y08 JAMES (�ELSON Suwveroa esT�eusMSO ��aa METROPOLITAN LAND SURVEYORB, c��weurMeu ��a+ Invoice 22876 �t1 , v � � �� r � ' � a -�, �' y • � Y__,, :�../ � D � � . �''`' ��-� R� � ^ �� tir�� -�- , �. '� - -�,. s�7 � . � � G / _ � � . .� .� � I hareby cartLy tli�:t this is a true and corrQat ropresent��ion of a survey OFS Lot 3, Block l, G�xdena r�Telolanc� Gardans �.s survey�d by me this 9th d�.y of AIovember� 1962. � " ^ ,�.... . ��. - ��' �- .� � ;� ��° . SIONED r...1 w` �" CA RIGHT wMD OL90N �:--�:'. � � � � � :° _� t� ro O � x Y � � � '� � � O � � � � x x x � � � � O v��z �r � � � �A 0 � � � � ��- �n � � m �a��o en � g o�i � � �� r , � y M w �' � � y � N ., x d�w�o� p � h�J ►�i C � � � n� � �s g � � .v�i � o F+ iE v' � � Ir � � : � ��: �� : : y � : : m : = �n . . . . � . : • • p. . . : : �.: i i i m � x � � � 0 O t" o� � � Zi < �' n � w oa " w � �� y x o � � o � � m A . A � • �: �: �: W H f� H �' � � � � � � � � � � f � o � � ►! � �, � y � f � \ �O e+ � � [y,�; , �j � �, � w K � � z � � o � � z 0 � � � � � 0 � $ � � R � °x � '+7 O � � t�! h9 d `�i �� m N aa � fD x � � O N o � � "� 0 0 � � s� R° R° � � � � � � � � � s' � � Q � o o � r'' o � � � � H � � ,e� : : � � : : x �d p . o � � � � : : � : � w w o 0 g � °o g �� O� � z � 8 � € � � � � �• n � � m � 0 � � �� 0 � � � g � � ��,� �x �•�'� � � �' � � R° �° eD p� � � � � � � ;� � r► o w w ro p, R° � O � F � � o e �Q � � � ° ° p' . (� �' R, � � y o a, � : G •• � C : : -� v � . . � 0 .° � : : � � � w a� o� w o S S S � o �� 8 twi� O "� � � �� 0 'a�d ��b�S �� m(� � � y fp � � � �° �° � w y �a�.� � � a � � w " R° �' 0 � � � 0 � � � � � � � a � � • a �' . � . . �rn ,°o : : � O ' • 0 . . � : : : � �e w o� o� o y °o °o o° g Nl � 0 � ao.� � �%'�� M � � p+� � p�� r � �. �. ;� y d�� e�► � M� O ��O � � , / y y 1-~-+�i '� rr ¢ �0�� m � � b �5'� � ��Mb p`a' � w � � �a�� p. y .b ►! �� b � a� ��. � a��. � y A H �� o x �' •. � �� m � I� � � � D � r � � m � 2 m C m � M. m � x V m � � � '�� ' O � �O o� �' o. 0 �� _ � � �� 0 � 0.� � � � �� ' d � / �� _ �. � HOUSE HEATING TEST RECORD ADDRESS �� C�E��i r�.�� !� APT. FLOOR CITY OCCUPANT ��i� I�a �-ej OWNER HEAT LOSS DATE HTG. INST. SOLD BY INSTALLED BY Eleehieal Work By Gas Line By _ TYPE OF HEAT GA FA �HW STEAM SPACE HTR. G S DESIGN MAKE - �1�r"�''�i��4 � MAKE OF BURNER Model 1��t�� Model Serial �� a+�'�` %6 Max. BTU Rating INPUT ? �.eA%� MAKE OF FURNACE — UNIT HTR. OTHER CONVERSION � .�. SUBURB �� . �,,,.� J �, Model CONTROLS - -- - _ THERMOSTAT � Heat Plug � �'� Vent 5ize ��` �° - - -- - Y°1V° ' KIND OF LINER SIZE NONE Limit ;��%� Draft Hood Regulato► Limit Sefting %�� 4' Filters Size � umber D F°^ S°tt�^9 Chimney Loeation Inside Outside Pllot Type ��'+��-!�` Chimney Construetion - � �" � (.�• �-� Pilot Make Pilot Model Smoka Bomb � Wiring Pilot Timing Draft �' =�'C Test Tag V L.W. Cut Off Door Pressuro Lighting Inst. ✓� Prossuro 3� � Percent COZ ` Date Tested - — Input CFH �� Pereent OZ� � Company Testing C� Staek Temp. �� Percent CO Name of Tester Form 235 - a � SuBJECT - - c�ty of Fridley 2 8 � � 6 ,`��6�� THE TWINS g�J I L D i N G P E R M I T R � • COMMUNITY DEVEIOPMENT DIV. i VV �� r � � PROTEC7IVE INSPECTION SEC. i . � � � /'��1 � CITY HALL FRIDLE� SS1J$ NUMBER pEV DATfi VAGE O� APPROVED BY �'""�" �'' 612-571-34b0 910-F15 12/21/98 / / J08 AODRESS 6025 Gardena Lane NE 1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACFIEO DESCR. 3 1 Gardena Meloland Gardens SHEET 2 PROPERTY OWNER MAIL ADDR�S$ ZIP PHONE June Berg 5 1-0551 J CONTRACTOR MAII ADORESS ZIP PHON� LICENSE NO PEM Millwork 5671 International P - 4 ARCHITECT OR DESIGNER MAIL AODRESS ZIP PMONE LICENSE NO. 5 ENGINEER MAIL ADDRESS 21P PMONE LICENSE NO 8 USE Of BUILDING Residential 7 CIASS OF WORK O NEW ❑ ADDITION O ALTERATION � REPAIR O MOVE O REMOVE 8 DESCRIBE WOHK 9 CHANGE OF USE FROM TO STIPULATIONS Install smoke detectors to meet the State Building Code - in each sleeping room and on each level of house. SEPARATE PERMITS ARE REOUIREO FOH EIECTfiICAL, PLUMBING. HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BEC�MES NUIL AND VOIO IF WORK OR CONSTRUCTION 2pNING SQ. F7 CU FT AUTMORIZED IS NOT COMMENCED VjIITHIN 60 OAYS. OF IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONEO FOR A PERI00 OF 120 DAYS A7 ANY TIME AFTER WORK IS COMMENCED NO OWIG. UNITS OFFSTREET PARKING I HEREBV CERTIFV 7HAT I MAVE fiEAD ANO EXAMINEO TMIS APPLICA710N S7ALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION SUFiTAX ANp ORDINANCES GOVERNING TMIS TYPE OF WpRK WI�L BE COMPLIEO WITH WME7MER SPECIFIED MEREIN Op NOT. TME GFIANTING Of A PERMIT �S3]SC) $�..SH DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OFi CAMCEL TNE pERMl7 fEE SAC CNARGE PROVISIONS OF ANY OTNER STATE OR LOCA� lAW REGUTATING CON- STRUCTION OR 7ME PERfORMANCE OF CONSTRUCTION �SS],2,rj Fire SC $3 76 PLAN CNECK FEE TOTAL FEE License SC 5.00 97.89 S�GN4TUAE OF CON'FACTOp Op AUTMOp�2E0 AGENT iD�iEr WNEN PROPERIV LIOATED THIS IS YOUQ PEf7MIT d � / � S�GN4TUAE O� OWNEA�� OWNEi1BU40Eii� iO�TE� Bl �NSP � O4iE NEW ' ADDN ALTER [l [� �� ConstructionAddress: Leg41 Descri�,ti�n: Owner Name & Address: Contractor: • CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION � Effective 1/1/98 �P� � �� Tel. !/ �"�l` �S"�/ MN LICENSE 1� �Ov%�z,g Address: �� / l�f�r,�/��r,�� .�5 r� ,r[%uJ � A� ct�� Tel. # �� l —l/�...� ,� Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on i[ to scale. DESCRIPTION OF IMPROVENIENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. � OTHER: ��.�t�ace� s ��e r �e �% a�v'�z � f��o-�s s` Construction Type: Driveway Curb Cut Width Needed: DATE: APPLICANT: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ �'r- o? a5° $ 3� °7� $ 1�� $ $ S� 0 0 $ $ $ $ $ 9��8� Estimated Cost: $ ,37f"�� °° (Fee Schedule on Back) � Ft. + 6 Ft = Ft x$ _$ Tel. # CITY USE ONLY 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 [ ] Not Necessary [ ] . .. BUII..DING 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 $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,Q01 to $500,000 $500,001 to $1,000,000 $1,000,001 and up FEES $21 (Minimum Fee is $21 plus surcharge) $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000 or fraction thereof, to and including $25,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,000 $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $100,000 $887.25 for frst $100,000 plus $5.00 for each additional $1,000 or fraction thereof, to and including $500,000 $2887.25 for the first $500,000 plus $4.25 for each additional $1,000 or fraction thereof, to and including $1,000,000 $5012.25 for the first $1,000,000 plus $2.75 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 width plus 6 feet times $13.50. 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 $15.75. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certifcate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. sue��Ct P NO. '' •; c�ty of Fridley 30600 i AT THE TOP OF THE TININS � � r L D 1 N� P E R M I T r ; � RECEIPT NO. � `V �_��_ COMMUNITY DEVEIOPMENT DIV. �y r � � PqOTECTIVE INSPECTION SEC. �vf� � � ' � � . , l--_. A��,.i CITY HAIL FRIDLEV SSI3Z NUM�EP REV OATE PAGE Oi APPROVEO 8Y � �� 612-571-34b0 91a-F15 12/22/99 / / 10B ADORESS 6025 Gardena Lane NE t IEGAL ��T NO. 9lOCK TRACT OR AODITION SEE ATTACHED oesca. 3 1 Gardena Meloland Gardens SHEET 2 PROPERTY OWNEq MAIL AODR�S$ 21P PMONE Stanton Berg 6025 Gardena Lane NE 571-0551 3 CONTRACTOA MAIL ADDRESS ZIP PMONE LICENSE NO Twin City Exteriors Co Inc 9060 Zachary Ln N, Maple Grove MN 55369 425-4737 4 ARCMITECT OR DESIGNER MAIL AODRESS ZIP PHONE LICENSE NO. 2535 5 ENGINEER MAIL ADORESS 21P PMONE UCENSE NO I 8 USE OF BUILDING Residential 7 CIASS OF WORK B DESCRIBE WOF;K Reside House 9 CHANOE OF USE FROM O NEW ❑ ADDITION O ALTERATION C� REPAIR p MOVE O REMOVE TO STIPULATIONS Call for building wrap before covering. �er�it Inspectro� ��°tl� INiI� �� Ma01e� To H�meo�ner To Pos� SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING. HEATIN(i, ''`� v vv. VENTILATING OR AIH CONOITIONING, 7HIS PERMIT BECOMES NULI ANO VOIO If WORK OR CONSTRUCTtON 20NING AU7HORIZED IS NOT COMMENCED V�1ITHIN 80 OAVS, Oii If CONSTRUCTION OR WORK IS SUSPENOEO OR ABANOONE� FOii A PERIOD OF 1�0 DAYS AT ANY TIME AFTER WOFiK IS COMMENCED NO DWLG. I MEREBY CERTIFV TNAT I MAVE READ AND �XAMINEO THIS APPLICATION 1 AND KNOW TME SAME TO BE TRUE AND CORRECT. A�L PROVISIONS OF LAWS yp�UATION AND OfiDINANCES GOVERNING TNIS TYPE OF WpRK Wll� BE COMPLIEO WITH WHETNER SPECIFIED HEREIN OR NOT. TME GRANTING OF A PERMIT �S �OOO DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLA7E OR CANCEL TNF pERMIT FEE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING CON- STRUCTION OR THE PERfOfiMANCE OF CONSTRUC710N $111.25 PLAN CNECK Lice e S�GNATUpE OF LON'AACTOA OA AUTMOpIZED AGENT 101�Qi .,�,e UN17S SC. STALLS SC $5 P IOCCUPANCVLOAO CU fT. f PARKING GARAGES $2.50 SAC CMARGE Fir SC $5.00 TpT L EE 123.75 1 7M1$ I$_Y�i�pMl= C L v d nart NEi74' ADDN ALTER �) [l [l ConstructionAddress : Legal Description: Effective 1/1/99 SINGLE FAMMILY AND DUPLEXES R-1 AND - �L�'� �� A R 2 � �� f� BUILDING PERMIT APPLICATION Owner Name & Address: Tel. # �� .S�S % Contractor: TWIN CITY EXTERIORS C0. , IN . MN LICENSE# 2535 Address: 9060 ZACHARY LANE N MAPLE GROVE, MN 55369 Tel. # 612-425-4737 LIVING AREA: GARAGE AREA: DECK AREA: OTHER: 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 Length Width Height Length Width Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. Construction Type: Estimated Cost: $ �,�� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: �a �C� APPLICANT: Tel. # 612-425-4737 Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL CITY USE ONLY $ �ee ��ctreduie c�t Re�erse �ide - $ �,� .001 of Permit Valuation (1/lOth%) $ ��— $.SO/$1,000 Valuation $ $1050 per. SAC Unit $ $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservadon Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] $ �� STIPULATIONS: � �� / � � � ,- � v ��. � * � D �� O � � � a -. r: �• 7 N � y. � N � A 1 � o � � O �� 0 �• a �• ui � A cD � � �O � � �' N t aC Q. o �D �� . � c, � � �V � � � � � � � o . '� 1� ; � �� C - � �. j �ti � � � � •- � m Z � � m � � Z � m rn � �A V O 0 � 2 � a cn .o �. 'O � � � � a a % � � O C OG � � v � m -i m r � � � \ � � v � � m C• 0 �l gs � _ � Z � C� O � �� D -i m �; , � � � � o � 3 � � Oy, �f. 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VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When realacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No () The venting system is plastiGPVC 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 current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. The existina combustion air is sized and installed to meet the cuRent codes and manufacturer's specifications. When required to install a new combustion air, it will be sized and installed To meet the current codes and manufacturer's specifications. Yes()No() Yes()No() Yes( ) No( ) When installing a new ventina svstem, the undersigned hereby verifies that it is a listed assembly and meets the cuRent codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Fumace 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 () A�pliance Tvae 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 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 Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date : CITY OF �RIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 FAX: (763) 571-1287 PE 0.:2004-014�25 � DATE ISSUED: 08/26/2004 ADDRESS : 6025 GARDENA LN NE PIN : 243024210013 LEGAL DESC : GARDENA MELOLAND GARDENS : LOT 3 BLOCK l PERMIT TYPE : BUII.,DING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING VALUATION : $ 2,743.00 NOTE: UNDERLAYMENT AS PER STATE BUII,DING CODE. REROOF HOUSE & GARAGE (23 S� TEAR OFF STATE LICENSED CONTRACTOR 1 APPLICANT HASTINGS RICHARD CONT (4051) 6331 RIVERVIEW TER NE FRIDLEY, MN 55432 OWNER BERG STANTON O& JUNE K 6025 GARDENA LN NE FRIDLEY, MN 55432 BUII.,DING PERMIT FEE FIRE SURCHARGE STATESURCHARGE,VALUE LICENSE SURCHARGE TOTAL 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 applicarion and know the same to be true and correct. All provisions of laws and ordinances governing this type of wor� 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 provisions of any other state or local law reaulatin� construcrion or the merformance of construction. Bldg � Date_6/Z SEPARATE PERMITS REQUIRED FOR �`Vpi?RK �TI�R THAN DESCRIBED ABOVE. 83.25 2.74 137 5.00 9236 NEW ADDN ALTER [ ] CITY OF FRIDLEY IC^ �t�o� (] 6431 University Ave NE, Fridley, MN 55432 [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: � �'� � �l� � ��/ °� Effective 4/1 /2004 (763) 572-3604 Bldg Insp (763) 571-1287 Fax � Do � -bl�a S.� Legal Description: Owner Name 8� Address: 5�� W l� ��2 �"� Tel. # Contractor. I� > L � � �Z ) ,� � � 7` �' a� C � MN UCENSE # �/ � .� � C Address: l ,-� i Z � ��= �` �% . � w.�� ,� �. Tel. # LMNG AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the bt, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft Length Width Height Sq. Ft Length Width Hgt/Ground Sq. Ft �3 s �,, Construction Type: �� '� �=' � C'� � � `� � ��' j` Estimated Cost: $ � �f ! �� Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$ DATE: `� � �� K APPLICANT: � ��-,-� ��-°�� Tel. # � ? 4 ' l �� Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ C., �� Fee Schedule on Reverse Side $ `_'.` $ $ � $ A' .� � V `V $ $ $ $ $ •�� 65% of Permit Fee .001 of Permit Valuation (1/10th°/a) $.50/$1,000 Valuation $1350 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 [ ] Not Necessary [ ] �, STIPULATIONS: BiJILDING PERNIIT FEE SCHEDULE The Cluef Building Official shall, before issuing permits �for the erection of any building or stivcture, 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 $1 to $5� $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,OQ0 $100,001 to $500,000 $SQ0,001 to $1,Od0,000 $1,0�,001 and up FEES $23.50 $23.50 for�first $500 plus $3.05 for each additional $100 or fraction thereof, to and including $2,000 $69.25 for first $2,000 plus $14.00 for each atiditional $1,004 or fraction thereof, to and including $25,000 $391.25 for first $25,�0 plus $10.10 for each additional $1,0� or fraction thereof, to and including $50,000 $643.75 for first $50,0� plus $7.� for each additional $1,000 or fraction thereof, to and including $100,0� $993.75 for first $100,�0 plus $5.60 for each additional $1,�0 or fraction thereof, to and including $5�,000 $3,233.75 for the first $500,�0 plus $4.75 for each additional $1,�0 or fraction thereof, to and including $1,000,� $5,608.75 for the first $1,000,000 plus $3.15 for each additional $1,000 or fraction thereof CUR� CUT ESCROW (Concrete Curb Streets Only) Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined rate 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. VERIFICATION OF FOUNDATION 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 ; �- Permit No.: �` `� �' " Building MECHA.NICAL � Inspections RESIDENTIAL APPLICATIC�N Received By: 7. 63-572-3604 CITY OF FRIDLE� nate xec'a: DATE l � Q YOUR E-MAIL ADDRESS�,�� i P�b93 Yl��, fG �YYI�i�.i'1P�J�1/�• srrE �+nD 2.� � �' �dl _ _ � d� p , TWS APPLICANT IS: O OWNER �ONTKACTOR PROPERTY OWNER/ TENANT CONTRA.CTOR SUBMIT A COPY OF YOUR STATE LICENSE WI i H APPLICATION PERNIIT TYPE TYPE OF WORK: nT�z�; i�3�Z COMPANl' NAME:_ CONTACTPERSON: STATE LiCENSE # � D'4� �nD�ss: 15200 25th Ave N#1 � ct�r Plymouth sTn� MN zrn 5�44Z Pxor� 763-476-1990 Fa,x 763-476-1143 � SINGLE FAMILY ❑ TWO FAMILY O NEW �] REPLACEMENT DETAILED DESCRIPTION OF WORK ❑ TOWNHOUSE ❑ p1,TERATION/REMODEL C a PER MS 16B.665 the permit feel cement of res den� al fixture� xcl�ud' g the f�es� $CTilO.Ohould refl ct nly therco t of labor ) improvement, installation or rep Labor cost under $300 =$15.00. Labor cost between �3U0 to $SQO = cost of labor x.05= _ FOR PROJECTS WHERE 1.ABOR EXCEEDS $SOQ, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEI'T WHERE NOTED. FI7CTURES: iWDICATE TOTAL I•1Ut�BER OF EACH BELOV� MODEL: � S�� Equipment Installed . , MFG� �� MODEL: 5�� IvffG: rav,i e�_1__ SIZE/BTU__ �G: �_ MODEL: FIREPLACE (GAS) $15.Q0 _.GAS RANGE/OVEN $10.00 �A/C 525.00 —�P1,pCE (WOOD) $35.00 , NEW GAS GRII.L $10.00 AiR TO AIR EXCHANGEER S15 —F�ACE $35.00 _GA5 UNTf HTR $10.00 , _BOILER $35.00 � —E- POOL HFATER $35.00 GAS DRYER $10.00 CHIMNEY LINER $10.00 — VEIdTiLATOR $15 00 WORK $10.� ,_GAS PIPING $] 0 00 — � .. - ..� DUGT _. ,., . .__. �+ �rp�y� � . _. ____.,....._.,,yy. �,::.�_—.��f-.�...�,4::�r�:s..,r.s�k.SF�i?�'.c��.�i'i�T9��1lVi'9fAS`< . : . ii'�c1 :.'��'��1 u`I��"`� °„��llc .�- ��t, t�". �'?��.. �L��.�t;��;�v��a ��,��.��:�.�.��.�a.,:<.,��-,� . :�-,�: _ �..._ es $10.00 x $10.00 = $ Permit Fee $ Number of fixtur @ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = � TOTAL DUE $ Number of fixtures @ $25.00 1 x $25.00 = $ . . �i' Number of fixtures @ $35.00 � x $35.00 = $� State Surcharge = $ .50 Tota1=$ �•. � THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNfII- PROCESSED 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 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 o all work w' h requires review and approttal of p s• � � C � 12 �� V _ � PRTNT N DATE,,� SIGNATURE OF APPLICANT � , „_ . - �,b City of Fridley Building Inspections Department . 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 F:�`t: 763-502-4977 �. REQUIREQ lNFORMATION NEEDED TO PROCESS PERMIT RE�IDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOME�IADDi�'IOi�S � EXISTlNG HOME ❑ MAKE-UP AIR t�EQUIRED FOR �E1N/EX1ST!l��(�_HOIVIES 1. Combustion Air (See no±e below) . a. Oil or solid fuel Il!-�C C;h.a�ter 7 with MN Amendm.ents b. Na�.u-al Gas or Propane/1FGC Chapter 3 with MN Ameudments � 2. Make-up A;r (See note b�1Qw) a. IMG Chapter 5�=.�itla MN Amendments 3. Venting a. Gas appliances IFGC Chapter 5 with MN A.mendmen.ts b. Fuel other than gas IMC Chapter 8 with MN Amen.dments REQUIRED FOR NEW H0147�5 4. Heat loss & cooling loa.d per room a. Required on new construction IMC 1346.0312 5. V entilation . a Per MN Energy Ccde 7670 or 7672 6. Duct Design Per IMC 1346.0603.2 a. ACCA Manual D NOTE: Centerpoint E�er�y Mechanical Code �uideiines soft�ware may be used fo� comliustion ancl make u� �� calculations