AF - 45529�
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City of Fridley, Min.n..
BUILDING PERMIT
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C..� _ � '- Builder
AdBress - Addre�
�,�D ���7
N° .6522
No. ���. Stc�et
Lot ._._� °�_ Hlock
Coraer Lot _ �`
Inaide Lot ._._ Setback
Sideyard ,,Z �
Sewer IIevation � � Founda.tion Elevation
DESCRIPTION OP BUILDING
T v , P
F'ront �� Depth ��'_[�— Height .��"-[� s9. F'� /���y�=� Ca. Ft
Fro Depth _�I�eight —��Sq. Ft Cu. Ft
Type of Constructio;o��i i��� _.. F�t. Cost �.����...�.. To be cemplettea
In consideration of the isauance to me of a permit to construct the building described above, I agree to do
th� proposed work in accordance with the d�scrlption above set Porth and in compliance wlth all prov3sfons oP
qrdinaac�s oE the dty of Fridley. '�
In consfderation of the payment of a fee of $��! � , permit ia hereby granted to
to conatruct the builciing or additlon as descrlbed above. Thiape rmit ia gisnted u�n
the express condition that the person to whom it fs granted and his agent�, employees and workmen, 3n all work
done fn, around and upon said building, or anypart thereof, shall ooffiorm in all respects to the orainances of
Fridley, Minnesota loc�tion, conatructt��on, altera.tion� maintenance, repair and moving of bufldings
wio�� � dty lim�its� permit may be revoked at any tu� u��olatf�Of any of the provisions of safd
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Building Inspector
NOTIC�
7�s psredf doa aof eerv t6s eo�lrudioe, 6ntaQgion �er vrMeg, plumbine, ga 6uHeg, avru� er wNsr. B� wn !e ae
Nh Bntldte� lesp�e�s� for s�parab p�rmHs foe t6�ss h�nn.
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I he�eb,� c�x�tify tllat the above is a true and� correct z�l.�t of a s�vey of s ' '�
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Lot 22, Blo�lc �, I-ARY:VIE'�J i:.�kS rIR�:T AllDITTGN, Anoka Coutity,' :�:i�nesots. �°:�
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tis .�urveyed by' m� thi,� 1.9th cia�q' of �'1pr�.l. 1-�00 A. D. Y'�
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"Ca�Y Gt1ERRE _ - .g
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APPLICATIQIV FOR BUILDING PERMIT
CIZ`Y OF FRIDLEif, MCNNESOTA
o��� s � � , � a � t� ��'� � �P° svn,n�x � � � �I � � � �
AIDDRESS ���► � �'p � f'( (� � �" r'Y� ADDRESS
LOCATION OF SU]I�DING
No. �� r� �' � Street � r,�� a � � :� `� �art of Lot
LoC `�• � Bl ck � Addition or Subdivision ��a v-16'� �� ib. C� p!�'�'
Corae� Lot '� Inside ot � i - j
L Setback � Side Yard � Q
SEWEIR ELEVATION FOUNDATION ELEVATION
Applicant attach to thie form Two CertificaCes af Survey of Lot and proposed build-
ing location drawn on these Certificates.
DESCRIPTION OF BUlLDING
To be used as;
�,� � � �� Front � 7 / Depth � �`� r Seight °
. Ft , I� � 4F �is Cu . P't . �+���� �+�--�=—
C� �°� y�\�� �+ ��a s�,�.�,.�r nC Depth Aeight
Sq. Ft. Cu. Ft.
Type of ConsCruction �,� Q � `'^
v-� Eatimated Gost � � `� �
To re Completed
��
3'he undersig�.ed hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordaace with the�Citq ot Fridley Ordinances and
rulings of the Department of Buildings, and hereby declares t$at all the facte and
representations atated in Chis application are true and correcC.
DAT� � ^ �^ � �Ca �i SIGNATT?I2E � �
(schedule of Fee Costs can be found on Che Reverse Side).
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BUILDING PERN�T FEE SCHEDULE
Sec�3on 2. The InspecCor of Buildinga shall, before issuiag any permit for
�he erection of any;building or etxucture, ar for anq addition to any exist-
ing building or struceure, or for any alterations or repaire to any e�iating
building or srcructure, u�on applicat3on therefor, require the payment by the
applicamt for auch permit of feea to the amount herein below seC forth end
iu the manner herein prwided to-wit:
2.1. For any such permit for ehe erection o.f any fi�ce-groof build�n�, other
than.a garage�.warehouse, factory or grain elevator, or for the erection of
�aay fire-proof addition, for similar occupancy, to anq exieting building,
shal,l be at tt�e rate of $1.40 for each one thous�nd cubic feet, or fraction
thereof, in such cubical contenta.
2.2. For any auch permit for �he erect�.on of any fire-proof garage, warehouse,
faetory or graia elevator, or for the erectioa of any fire-proof addition,
£or similar occupancy, to any existing building ahall be at the rate o� �1.25
_ for each one thoueand cubic feet, classified as 11fireproof" by Sec�tion 502 of
� . J-the M�.nneapolie Building Gode: � � �
�OUSES �- -
2.3. For any such.permit for the erection of eny non-Eireproof buildiag othes
than a garage, warehouse, factorq or grain elevator, or any non-fireproof
addition, for similar occupancy, to any esistiag building - permit $1.00 for
each one thousand cubic feet.
�t��AGES
2.�.. For any such permit for the erection of any non-fireprooc gasa�e,
wGrehouse, factory or grain elevator, or for Che erection of any non-firegr�
acldit��n, €or s3milar occupancy, to acay existing building or for each auch
_ �ui.ld3ag or addition - ainety cents ($0.90) for each on� theusand cubic feet
or fraction thereof, ia Che cubical c�ntents thereof with a minimv�nn of $4.Oa.-
For the purpose of camputing fees for building permits, the cubical contents
of any buildiag og additioa to a uniform height throughout by mult3plying �I�-e
ground area covered from a point six (6) inches below the floor liae of the
r�semeat or cellar to the average he3ght of the uppes aurface or to the
average height of Che roof surface of the maia gable of a p�.tched roof.
2.5. For repairs or alterationa to an exiating atructure, the fee e�all be
at the rate of $3.00 per each Five Hundred Dollase ($500_OD) or fraceion
th�reof ia the coat of all proposed work.
2.6. In- no CBBe'�5�18�,1. tiZ1(i �H�?, C�]AT�Pd �OT aup p�rrn�t as eet forth in
Sectian 2 6e less than $4_OU.
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SUBJECT PE
City of Fridley o 1810 5�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
�
� �� RECEIPT NO.
� �y------ �
COMMUNITY DEVELOPMENT DIV. ��
r j � PROTECTIVE INSPECTION SEC. f�� �
� ; i
i-_-- A ��'��,'� CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BV
i �� 612-571-3450 910-F15 7/10/85 / /
JOB ADDRESS 1202 Hatha�aay Lane N.E.
t LEGAL LOT N0. BLOCK TRACT OR ADDITION
DESCR. 22 2 Pa leW Od.ISS ZS't SHEETTACHED
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Mi.chael W�lsh. 1202 Hathvaay Lane NE. 571-2655
3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PNONE LICENSE NO.
5 ENGINEER MAtL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residenti�,l
7 CLASS OF WORK
❑ NEW C� ADDITION � ALTEAATION ❑ REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 28� .x 12' Deck ontr� Back.of Dwelling
9 CHAN(3E QF USE FROM TO
STIPULATIONS
SEPAP���`� PERMITS R-EQlD1RED FOR 8ef�pe �Q�AI��
UV�IRII� ; HE�ATiNG, PLUMSI�VG AND SIGNS. TF�EP#�a�r����' �p lo� �.
��- flfCTj��C, �A���r1�;
REQV�REO ���,
gY �� IN
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY (3ROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION 1. STALLS GARAGES
AND KNOW THE SAME TO BE TAUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $2 � 250 $�.. �.3
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $'38 e SO
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
AN CHECK FEE TOTAL FEE
$ 9.63 $49.26
SIGNATUREOFCONTRACTOROHAUT oa ED GENT IDATEI WHEN PROPERLV LIDATED THIS IS YOUR PER IT
����� ��� � � �� � /�'� � ' Q
SIG URE OF OWNERiIF OWNER BUII,DERi IDATEi BLOG �NSP 7
N� [] City of Fridley Effective 4/1/84
ADDN. [�-] I R-1 AND R-2
AL,TER. [ ] Building Permit Application
���'' ->� �/��`L���a � �✓� �l/�
Construction Address: �'
Legal Description: l�T �'� ���C �� °� ,���'��'' �") ���� �
Owner Name & Address : ��i��e' �'./ ���/� `i Tel. � ���'�����
Contraetor • ..��'� �- Tel . # ��� ����
Address•
Attaeh to this applieation, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTIOH OF IMPROYEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECR AREA: Length � Width � Hgt/Ground � Sq. Ft. ��
r� «
OTHER: q
� 0 � .� � ` � �7, �
Corner Lot �1 Inside Lot [] Ft. Yd. Setbaek Side Yard Setback
Type of Construetion: ���°%+ � Estimated Cost: $ '��
Approx. Completion Date: �����
2�
Alt. A Alt B
Proposed DriveWay Width If New Opening Is Desired: $ $
See Back Page for Explanation
DATE: �° � APPLZ('ANT: 7!!� �.�C r � `�?/�°% � Tel . � s�� �� `�°�
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Se�er Main Charge
TOTAL
STIPULATIONS:
CITY IISE ONLY
$ �� `= °' Fee Schedule on Reverse Side
$ •�P � 25� of Building Permit Fee
$ f.f� $.50/$1,000 Valuation
$ $425 per SAC Unit
$ Fee Determined by Engineering
�
s�� Agreement Necessary [] Not Necessary []
$
BIIII.DING PERMIT FEE SCHEDIILE
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 applicatior�
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 Valuation
�1.00 to �500.00
$501.00 to $2,000.00
$2,001.00 to $25,000.00
$25,001.00 to $50,000.00
Fees
$10.00 (Minimum Fee is �15.00)
$10.00 for the first $500 plus $1.50 for eaeh
additional $100 or fraetion thereof� to and ineluding
$2,000.
$32•50 for the first $2,000 plus $6.00 for each
additional $1�000 or fraetion thereof, to and
including $25,000.
$170.50 for the first $25,000 plus $4.50 for each
additional $1,000 or fraction thereof, to and
including $50,000.
$50�001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.00 for each
additional $1,000 or fraetion thereof, to and
including $100,000.
$100,001.00 and up
�433.00 for the first $100,000 plus $2.50 for each
additional $1,000 or fraction thereof.
DRIYEWAY DEPRESSION ESCROiI
(Conerete 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
approaeh With 6 inch depth - Driveway Width plus 6 feet times $15.75
VERIFICATION OF FOIINDATION
Permits far construction Will be issued a minimum of 24 hours from the time of
application to allow for proper reviex of the proposed structure and of the
construetion site.
A CertiPicate of Survey of the lot, showing the location of the foundation once it
has been eonstructed will be required before proceeding With the framing.
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, . . � �, a�r
sue�ecr PER NO.
City of Fridley 9 9 3 4 4
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � RE .
� `y _ COMMUNITY DEVELOPMENT DIV. � �O �
r � � PROTECTIVE INSPECTION SEC. �
1 . ,
, � /�"1 � CITY HALL FRIDLEY 5B432 NUMBER REV. DATE PAGE OF APPROVED BV
�""� � ,'� 612-571-3450 910-F15 3/16/88
� �
JOB ADDRESS ]_2O2 Hathaway Lane N.E. ,
t LEGAL �OT NO. BLOCK TRACT ON ADDITION SEE ATTACHED
oESCR. 22 2 Parkview Oak�s First Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Mike Welsh 1202 Ha.thaveay Lane N. E. 571-3416
3 CONTRACTOR MAIL AODRESS ZIP PHONE LICENSE NO.
The 1lnierican Handyman Const. Inc. 1202 Hatha.way Lane N.E. 571-2655
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS 21P PHONE IICENSE NO.
8 USE OF BUILDING
Re sidential
7 CLASS OF WORK
� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install ba window and arage door
9 CHANGE OP USE FROM TO
STIPULATIONS
5ee notations on plan
SE�AR�1iE PE�MITS RE�QUIRED FOR
I�J6�i�1G, H�A�'l�3�, PLU�9BING A�D SIGNS.
SEPARATE PERMITS ARE HEQUIRED FOR ELECTRICAL, PLUMBINO, HEATING, �PE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK Ofi CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. • NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTtNG OF A PERMIT $2 IQQ� S�-.00
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $32.50
,�/� % P AN CHECK FEE TOTAL FEE
'%`�L� � �� � ���� $33 . 50
SIGNATUREOFCONTRACTORORAUTHORIZE AGENT IDATEI s�,°fWHEN PROPERLY I ATED T IS IS VOUR PERMIT
�
SiGNATURE OF OWNEAIIF OWNER BUILDERI �DATE� BLOG INSP �� �
qaTE
NE4J L �
ADBN. [ ]
pLTER. L�
Construction Address
,
, {
City of Fridley
R-1 AND R-2
Building Permit Application
.
� • � , �.
Effective 4/1/86
,i%� J'd/�°"
Legal Description:
Owner Nante & Address : `'��` U //�� � Tel . $ � %�" .� y��
Contractor: �� �c'�re �� /���o ��^�u�� �� �7C .; Tel. ���/�'���.�
. �
Address:
�
� �� �
Y
Attach to this application, a Certifieate of Survey of the
lot, with the proposed construotion drawn on it to scale.
DESCRIPTION OF IMPR09EMENT
LISiING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft. ��
OTHER: v4 ���%� �,� �l �� �� � �� ��o��
Corner Lot � Inside Lot [] Ft. Yd. Setback Side Yard Setbaek
�
Type of Construction: Estimated Cost: $ �`'��
Approx. Completion Date:
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
D�TE: � "� �� APPLICANT : s /��C'�� ��,�,� Tel . ��%� �� ��'°�
CITY IISE ONLY
Permit Fee � �
Plan Check $ �.
State Surchar�e $ �� � �
SAC Charge $
Park Fee $
Sewer Main Charge $
TOTAL $ ��+�
,� _. .
STIPULATIONS: � ��°�_. __- v�`
Fee Schedule on Reverse Side
25� of Building Permit Fee
$•50/$1,000 Valuation
$ �,�p per SAC Unit
Fee Determined by Engineering
A�reement Necessary [ J Not Necessary []
BUILDING PERMIT FEE SCHEDULE
Ti-.e Chief Building Officisl shall, before issuing permits for the erection of any
�i�ilding or structure, or for any addition to any existing building or strueture, or
for any alteration or repair to any existing buildin� or structure, upon applicatio n
tY.erefore, 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:
Tota],_- Valuation
�i.00 to $500.00
Fees
$10.00 (Minimum Fee is $15.00) �
W501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for eaeh
additional $100 or fraction thereof, to and including
$2,000.
�2,001.00 to $25,000.00
W25,001.00 to $50,000.00
�50,001.00 to $100,000.00
W100,001.00 and up '
�32•50 for the first $2,000 plus $6.00 for each
additional �1�000 or fraction thereof, to and
including $25,000.
$170.50 for the first $25,000 plus $4.50 for eaeh
additional $1,000 or fraction thereof, to and
ineludin� $50,000.
�283.00 for the first
additional $1,000 or
including $100,000.
$50,000 plus $3.00 for each
fraction thereof, to and
$433.00 for the first $100,000 plus $2.50 for each
additional $1,000 or fraction thereof.
DRIYEiIAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
klternate "A": Removal and replacement of curb and gutter only - Driveway width plus
6 feet times $13.50
Alternate "B": Reaoval and replacement of curb and gutter and install a 3 foot wide
spproaeh with 6 inch depth - Driveway width plus 6 feet times $15.75
VERIFICATION OF FOUNDATION
Per�its for construetion 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 onee it
has been constructed will be required before proeeeding with the framing.
` �
0
SUBJECT
c�ty of Fridley
AT THE TOP OP THE TWINS g � I L D I N G P E R M I T/
i �
� �
� • COMMUNITY DEVELOPMENT DIV.
r � �' � PROTECTIVE INSPECTION SEC.
i� i �
---• A �/'�',.� CITY HALL fRIDLEY 55432 NUMBER REV. DATE PAGE OF
t �� 612-571-3450 910-F15 9/10/92 / /
JOB ADDRESS �02 Hathaway Lane NE
1 LEGAL �OT NO. BLOCK TRACT OFi ADDITION
DESCR. ZZ 2 Parkview Oaks First Addition
2 PROPERTY OWNER MAIL ADDRESS Z�P
Michael Welsh 1202 Iiathaway Lane NE
3 CONTRACTOR MAII ADDRESS Z�P
American Handy�man Can 2835 Central Ave NE, Mpls., MN 55418
4 ARCHITECT OR DESIGNER MAIL ADDRESS Z�P
5 ENGINEER MAIL ADDRESS Z�P
8 USE OF BUILDING
Residential
7 CLASS OF WORK
8 DESCRIBE WORK
Reroof Dwe
O NEW � ADDITION � ALTERATION � REPAIR
9 CHANGEpFUSEFROM
(.30 Square�� Tear^o,�f
ro
STIPULATIONS
Underlayznent must comply wa.th the �tate Buildinq Code.
TYPE OF CONS7. OCCUPAN
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION ZONING Sa. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. N0. DWLG. UNITS
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1' STALLS
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1 5�O
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT r
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE
ROVISIONS OF ANY OTHER STATE OFi LOCAL LAW REGULATING CON- $3'].00
TRUCTION OR THE PERFORM� E O�y C.ONS RUCTION.
' �� �-S � ' _ PLAN CHECK �EE
.. °� License SC $5.00
SI NATURE OF CON RACT017 OR AUTMOR12ED AGENT IOA EI �lHEN.ARdPERL1L VA61
IDATEI
.,�.�� � �.y.
�
21541
�� �
APPROVED BV
SEE ATTACHED
SHEET
PHONE
571-�3416
PHONE LICENSE NO.
t-2881 3887
PHONE LICENSE N0.
PHONE LICENSE NO.
❑ MOVE ❑ REMOVE
OCCUPANCY�OAD
CU. FT.
OFFSTREET PARKING
IGARAGES
SURTAX
� a 8�
SAC CHARGE
Fire SC $1.59
TOTAIFEE
$44.39
D THIS IS YOUR PERMIT
� `� /� -�'�
nPTE
NEW [ ] . Effective 3/ 11�2
ADDN [ ] CITY OF FRIDLEY
ALTER[ j SINGLE FAMILY AND DiJPLEXES R-1 AND R-2
Building Permit Application
Construcdon Address:
Legal Description:
/V �
Owner Name & Address: i c� �i � e�� �e�f � Tel. # S 7 f-'� 1/ � �
Contractor: � ./-�T���� ��;;.�—�q,� ./�� ���( _ �1, MN LICENSE #Ud ca 3 �b' %
Address: � � � _S ��.�7`��. f �v� � � . % � Tel. # ��i�� o �>
�
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the propvsed construction drawn on it to scale.
DESCRIPTION UF IMPROVEMENT
Length Width Height
Length Width Height
I.engch width xgr�Gmund
%LS:
Corner Lot [] Inside Lot j] Ft. Yd Sstback _
Ty� of Consiruction: � �,, �, �� � �P� e �
Approx. Completion Date:
Driveway Curb Cut Width Needed: Ft. + 5 Ft =
Sq. Ft.
Sq. Ft.
Sq. Ft.
Side Yard Setbacks
Estimat� Cost: $ /� �%D �
(Cost on BacJc)
Ft x $ _ $
DATE: "� G - % APPLICANT: o� ,�.�,.� �� �`�'//O ��, Tel. # �l�l � - i��,�J
, ��-� ��-, -�--P
Permit F� $ � `% OD
Fire Surcharge $ / � ��i
State Surcharge $ � c°� ('�
SAC Charge $
License Surcharge $ �• �' p
Driveway Escrow $
Park Fee $
Sewer Main Charge $
TOTAL
STIPULATIONS:
$ ��. ��7
��i�•�i_�� �!�i�
F� Schedule on Reverse Side
.001 of Pemut Valuation (1/lOth%)
$.SO/$1,0� Valuation
$700 per SAC Unit
$5.00 (State Licens� Residential. Contractors)
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary j J Not Necessary []
a
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 struct�rre, or for any alteration or repair to azry existing
building or structure, upon application therefore, require the paymem by the applicant for such permit
of fees to the amount herein t�low set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$SOl to $2,OOQ
$2,�1 to $25,000
$25,001 to $50,000
$50,001 to $1�,�
$1�,001 to $500,(�0
$5�,001 to $1,000,�
$1,OOU,001 and up
FEES
$1 S(Minimum Fee is $15 plus surcharge)
$15 for first $50(? plus $2 for each additional $100 or
fraction thereof, to and including $2,000
$45 for first $2,000 plus $9 for e�ach additional $1,000
or fraction ther�f, to and including $ZS,UDO
$252 for first $25,(�l0 plus $b.50 for each additional $1,OD0
or fra.ction thereof, to and including $50,000
$414.50 for first $SO,OOQ plus $4.50 for each additional
$1,000 or fraction thereof, to and includiag $100,(�0
$b39.50 for first $1�,�0 plus $3.50 for each additional
$1,(�0 or fraction thereof, to aad including $500,000
$2039.50 for the first $5�,000 plus $3 for each additional
$1,000 or fraction thereof, to and including $1,(�0,000
$3539.50 for the first $1,�,000 plus $2 for each additional
$1,�0 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Altemate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 f�t times
$13.50.
Alternate "B" : Removal and replacement of curb and gutter and install a 3 foot aride
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 praposed 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.
,
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COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstnactions,
and is securely supported and firestopped where required. �(es () No ()
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No ()
The undersigned also verifies that the replacement unit i� 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 existina combustion air is sized and installed to meet the current 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 installina a new venting svstem, 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 Fumace
Venting Tables for fan assisted and natural draft appliances. Yes () No ()
Is the common vent and vent connectors sized and installed coRectly after
an appliance has been removed from the common vent and vented
separately as per cuRent codes. Yes () No ()
Appliance Tvpe and Size/Common Went and Vent Connector Inf�rmation
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 Conne�tor 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 :
_
C[IYOF
FR[DLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
February 7, 2003
Mr. D. Hassan
1202 Hathaway Lane NE
Fridley, MN 55432
Re: Final Inspection at 1202 Hathaway Lane NE
Contractor: Pierce Refrigeration
Dear Mr. Hassan:
A mechanical permit was issued on March 8, 2001 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 permit fee that was paid covers the inspection to make sure the work was completed
according to the Caies. We will keep your pernut 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 pemut "no
inspection called for by homeowner after notification" and take no further action.
To set up the inspection or to ha.ve any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
QinrPralv
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