AF - 46194. � � sueaec* - . � � � PE
� City of Fridley ° 1 39
AT TME TOP� OF�: THE TWINS
�-�' BUILDING PERMIT
� � RECEI NO.
• COMMUN�TY DEVELOPMENT DIV. �
� �y ------• . . �
� f � . � vROTECTIYE,tNSPECTION SEC. . . �
�
� � /"9 • CITY HALL FRIDLEV 55�32 NUMBER flEV. WTE oAGE OF .� APPqOVEO BY
i..__h-• ,�+ 6,z�.,�� 910-F15 19-3-75 / /
JOB ADDR€SS 5g34 Hackmann Avenue N. E.
t� LEGAL LOTNO. BIOCK TRACTOAAD�ITION SEEATTAGHED
�DESCR. �fj � 6 4 ParkVleW-Mdnor SHEET
2 PROPERTY W MAI D E S � � ZIP PHONE
�Cli�f Kucera �8�3� t�ackmann Avenue N.E.
��3� CANTRq�jp� - MAILADORESS ZIP PNONE� LICENSENO.
JFUN
Y ARCHITECTOqDESI�NER MAILA�ORESS ZIP � PHONE LICENSENO.
5 ENGINEER MAILAODRESS ZIP FHONE LICENSENO.
8 USE OF BUILDING
residential
7 CLASS OF WORK
� ❑ NEW ❑ ADDITION ❑ ALTERA710N � REPAIR ❑ MOVE ❑ REMOVE
8 OESCRIBE WORK � -� .
reroof (will remove existing roof)
. 9 CHANGE OF USE PROM TO '
STIPULATIONS
9EPARATEPERMITSAREFEOUIREDFORELECTRICAL,PLVMBING,HEATiNG, TMPEOFCONST. OCCUPANCVGROUP OCCUPANCYIOAD
VENTILATING OP AIR CONOITIONING. �� � SrI�R �
�TMI$ PERMIT BECOMES NULL AND VOID IF WORK QR CONSTFUCTION ZONING� � S�.FT. CU.FT.
�� AUTNORI2EP IS NOT COMMENCED-WITHIN 60 DAYS, OR IF CONSTRUCTION .
� OR 1MORK IS SUSPEN.DED OR ABANDONED FOR A PERIOD OF 120 DAYS AT �
� ANY TIME AFTER VJflRK IS COMMENCE�. � � NO. DWIG. UNITS�'.` OFPSTREET PARKWG
I�HEREBV CEATIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
ANDKNOWTMESAMETOBETRUEANDCONBECT.ALL�PROVISIONSOFLAWS VALUATION SURTA%
� AND �OROINANGES� GOVERNING THIS TYPE OP WORK WILL BE COMPLIED d'� �MO . rjO
WITH WIfETHER SPECIFIED HEREIN OH NOT. THE GRANTING OF A PERMIT •P VV
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PpOY1SIONS OF.ANY OTNER STATE OF LOCAL LAW REGULATING CON- � .
STRUCTION-0R TNE PEAFORMANCE OF CONSTRUCTION. 6,
PLANCHECKFEE - TOTALFEE
6.50
SIGrvnTUnEOFtONrneCropoqnUTHOR¢EOeGEN* �MTEi . EN PROPERIY A IOATED THIS IS YO/U/�R�� PERMI�T y
^ � E� I �/ � /, �
0.��RE0 � E OWNER801LDERI � �OATB �8L ..IN�P DPTE
�
APpLICATION FOR RL'•SIDEN'T1AL, ALTI:RA'PION,
OR AllDITION BUILDING PIiItMIT
CITY OF PRIDLEY, DIINNL-.SOTA
OWNER'S NAME• �f% �3i�� BUILDER•
ADDRESS : �p d y- 14.� ADDRESS :
�
,,y3 J� � �
NO •, a V STREET • �A-G%�.o,.,,� �',,._� 7�
LOT:�BLOCK: �7-e+i'i � ADDITION: �✓J�.e �,.���� �!i�LC�zr—£/
CORNLH LOT: INSIDE LOT: SETBACK: SIDL^'YAP.D:
Applicant attach to this form Ttao.Certificates of Survey of Lot and proposed
building location d:awn on these Certificates. ^
DESCRIPTIO:V OF 13UILDING
To Be Used As:
Front: Depth; Height
Square Feet: CuSic Feet:
Depth• _Height:
Square Feet; Cubic Feet
d/
Type of Construction:�� EsCimated Cost:� /� �--r�
To Be Completed:
The undersigned hereby makes applicativn for a permit for the work herein
specified, agreeing to do all work in stiict accordance with Che City of
Fridley Ordinances and rulings of the DepartmenC oi I3uildings, and hereby
declares that all the £acts and representations st-ated in this application
are true and correct.
DATE:
S IGNATUF.E ;
(See Reverse Side For Additional Informacion.�
r
�����
,:a ��' ��
suut[r
c,ty of Fr�aiey 2 9 0 3 7
.� •T'�E'°"°"�E�'NS BUILDING PERMIT qECEiPT
� ` CpMMUNITY DEVELOPMENT DIV. /� /O
r � y •� PROTECTIVE INSPECTION SEC.
I
� i /•"1 . CITY HALL FRIOLE� 55�72 MYMBEN MEV D�TE o�GE O� �oMOVEO BY
�---'� � �'' 612-571-3450 9t0-Pt5 3/22/49 / �
JOB AODRE55
5834 Hacl�ann Avenue NE
1 LEGAL �OTNO. BLOCK TRACTONADDITION SEEATT�CMEO
oescn. 15,16 4 Parkview Manor SMEET
t PHOPERTYOWNER MAIL�DDRES$ ZIG PXONE
Doretta Kucera 5834 Hacl�ann Avenue NE 571-0588
J CONTRACTOR MAIL ADDRE55 Zli pHONE LICENSE NO
Grussing Roofing Inc 4305 Shady Oak Rd, Hopkins, MN 55343 935-0557 9212
a ARCNITECi OR �ESIGNER MAIL AODRE55 ZfP PHONE UGENSE NO.
5 ENGINEER MAIL ADDFESS 21P PMONE LICENSE NO
6 USE OF BNLDING
Residential
7 C1A550P WORK
❑ NEW ❑ ADDITION ❑ ALTERA710N �7 REPAIR ❑ MOVE ❑ REMOVE
8 OESCRIBE WORK
Reroof House & Garage (30 Sq) Tear-off
9 CHANGE O: USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
GONSTRUCTION WORK HOURS: 7:00 am to 9:D0 pm, Monday thxu Fxiday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
7YiEOFCONST. OCCUpANCYGROUP OCCUPANCY�OAO
SEPARATE �ERMITS ARE REOU�RED FOR EIECTRICAL, P�UMBING. NEATING.
VENTILATING OR AIR CONDITIONING
TMIS PERMIT BECOMES NUII ANO VOID IF WORI( OH CONSTRl1CT10N 20NING SO.FT CU iT
AUTHpRIZEO IS NOT COMMENCED WITHIN 60 D�YS. OR Ii CONSTRUCTION
OR WORK IS SUSOENDED OR ABANOONED iOR A PEH100 OF iNl DAYS �T
ANY TIME �FTEN WORN IS COMMENCED. NO. DWLG. UNITS OFf57PEET VARKING
I MEPEBY CERTIFY �Mq� 1 MAVE pEAD �NO E%AMIHEO 7MI5 APPLICATION 1 STAlLS GARAGES
ANOI(NOWTXESAMETOBETRUEANDCORRECT.ALLPROVISIONSOF�AWS yq�UATION SUfiTR%
AND ONOINANCES GOVERNING TMIS TYPE OF WORN WILI 8E COMG�IEO @
WITH WHETMER SPECIFIEO MERE�N OR NOT. THE GRANTING OF � GERMIT �Z�SJL w1.29
DOES NOT PRESUME TO GIVE AUTMpqITV Tp VIOIATE OR CANCEL TME pERMITFEE SACCMARG
PPOVISION$ OF ANY OTHEN $T4TE OR LOCAL LAW RECUl4TING CON� @
SiHUCTIpN OA TME PERFOfiMANCE OF CONSTRUCTION $74.75 Fire .pZ. S7
PLRNCNECKFEE T07A�F
Lice S $5. 0 83.61
YGH�tUAEO�COrv'A�CtOAOA�u*«Oa�2E��GEro� �O��L EN V OP IDATE I$ Y R P pMiT
��
$.GNSl�qEO�OWNEQavOWNFABU�IDEai �D��E� y0 r�i�t
NEW
ADDN
ALTER
Ll
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ConstructionAddre
Legal Description:
Effective 1/1l98
CI1'I' OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 31
BUILDING PERMIT APPLICATION �(,�O ��D
�
Owner Name & Address: QO r e 1-�'f} /�G�C �rCL Tel. #� 7/ —D S 8�
Contractor: � hU.� S� i'/ut9 � 0 C�r'N�,, %/�.G MN LICENSE N qci 1�--
gs3`j5
Addtess: I-f�0 S� S hcL�r.� ��/�- � dlo�i'/vS f��i( Tel. # 43 S— O� 5�
LNING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Construccion Type:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
DESCRIPTION OF IMPROVEMENT
Width Height _
Width Height _
Width HgtJGround
� / < --^ n ,s ,. �i-
Sq. Ft.
Sq. Ft.
Sq. Ft.
• c� � rin� `v�i
, �2S�j i
_ Estimated Cost: $ c-��
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: _Ft. + 6 Ft =_Ft x$
e
DATE: �l' 7� APPLICANT: � Tel. #�' � S— �S Sr7
CITY USE ONLY
Permit Fee
Fire Surcharge
State Surchazge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
TOTAL
STIPULA ONS:
�
$ � .. S�
$ �. $�7
$ 1� �9
$
� d
$
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
$ 83. (��
Agreement Necessary [ ] Not Necessary [ ]
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tacv-qcFtnr
JUN-08-2001 14=06 FROM C1TY OF FRIDIFY TO 4979249 P.03i6C3
COMIMON VENT. VENT CONNECTOR AWD COMBUSTION AIR VERIFICATtON
YYt�an � aa �o fivane� tl1e trx�a� (�py v� tl►at U�e
ren�ng t�as bean e�nmir�sd and is iroe iom nu� da0erioraGOn. abstrudbns.
and is seqrely suppariad and �oPPed whae reQ�ied. Yes () No ()
T� �^�^9 $Y+�m � P��C arltl rnests aA u/rMt �Odes end trw�dac�er
SP�or�s indu�n9 si�. largw� ia�mber of olbowra and i�on. Yes () No ()_
T� ��o vsr�ies Y�at ihe roplaoement urtit's a isbd a�empby
and meets tlie a+rerd codes and narMfadir�c spedBqYp�s. This does
i�clude AC,141iAMA Calegory i Central A+nace Verlig Ta61es tor fan
ssais�d and �dp�al drak a�p�r►oes.
The oxisting com tlon air is sized and irotalled to me� lhe ar�t oodes
and snanufaGureYs speafications.
..
L:� :j�
i. _ _ _
Yes ( ) No ( )
Yes ( ) No { )
Yes ( ) No ( ) _
IMten fAStal�tw a naw reM�►n svarn� 1hs uder�d t�ensby varifies tlmt
it is a�Ded a�r�bly and meals 1he a+rant codes and menufaduers
spe�alions. This does indude IbQM`„�IMA Cabgory 1 GetNrel Fumace
VM� Tabks for fan aeaisied �d nahoal draR appianost. Yes () No (}
Is the tarnnal Ye�►t and ve11t oolrletlota eaoed atld i�a6aled catRCtlyt aA�er
� aPP� 4as Oeen remor�ed �nrom �e canrran rent and ve��led
sepera�eN ae per arrE.�nt cades. Yes ( Y►'b f!
�.� •.,� ��...� ;,.
� -- - ,::..�
aPi�eno� �7 TIIPe 8'i!J Inq�t ' Fan Ats�ed ar Nat
�O�PP� �2 Yype 8711 Yipi�t Fan llss�ad oc t�t
�ADP� T �� Fan Assieisd a Nat
Common Vatt 7ype Vent hieigM p�ef �
APP�oe ff Vent Calnetlorl�feipf�t It I.englp R Ofamel�u in Type
APP�e �^ Vent Ca�rador F�kight R Lecgih R Dierr�eter in Type
APp� �i Ve� CaxNda Fiaiyht R Ler�Ih 1t Diankkr 6i Typa.
_
AlTERA'fIWrS: (Deacri6ef - --- - — -
� � ' �� �- �.' � �� �� � � , % �
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CITYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
Juivary 31, 2003
Ms. Doretta Kucera
5834 Haclanann Avenue NE
Fridley, MN 55432
Re: Final Inspection at 5834 Haclanann Avenue NE
Contractor: Knight Heating & Air Conditioning Inc
Dear Ms. Kucera:
A mechanical permit was issued on August 24, 2001 to install an air conditioner 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 perm►it fee that was paid covers the inspection to make sure the work was campleted
according to the Codes. We will keep your pemtit open for another 30 days and if we do
not hear fram you within this time to set up the inspection, we will mark the permit "no
inspection called for by homeowner after notification" and take no fiuYher action.
To set up the inspection or W have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
Sincerely,
DJ/mh
,