AF - 46171City of Fridley, Minn.
�UILDING PERMIT
N° 4554 �
Date• �'° �`7
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Owner: ---..�:. .....----- - -...,�___ . _' Builder - .
Address--•-•--••---------....'..�.��.____.._..__. _____._ _ Address _..-------------.._..._.-.-_•-•.._.-----_.........____......_.._.__...._......._..._.._.._...
6 ". CATI N t�F BUILDING
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No. _._L....�` .�Street __ r.�,,r. -••.�`°=-r�-t:�-•�.-..�``��._........_._..__._� .._........-----..._..._ P `oP Lot ....�--�.._�.. � ,.--.._-------- � -.-----T
Lot .....- ....................._........ Block ....._.._�............_........------ Addition or Sub-Divisioa�a-���.�-�"--•��-----���
, �, �y �
Corner Lot .........................._........ Inside Lot ....._..�......_........ Setback --�--„�".�..........._..__. Sideyard --��----•�--------•--��-�----.._�..-��-------.. _.
Sewer IIevation
Foundation IIevation
DESCRIPTION OF BUILDING
7�� 9 / / ��j'
To Us a •
�_ ..�4.���..._ Front �...+L==---- DePth ......�_�.. Height _�._� Sq. Ft f...�� �-� Cu. F� �%�
�-�-f_'y.�. ��-l� ---�--.... Front ....��.. Depth . ...��. � �ight /,�.��.. -1�.�.. Sq. F't. ..�.�_., ��.. Cu. F'L ....._ .............---
Type o Construction _....�..�...��''�'�`z� Est. Cost.�..�_--.:���......._........ To be Completed ....._......_....._......_....._......._........
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In conaideration of the issuance 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 oP the dty of Fridley. ,_
In consideration oP 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 workmen, in all work
done in, around and upon sa.id building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, re�air and moving of buildings
within the dty lim�its and this permit may be revoked at any tulne ��rviolation �f any of the provisions of said
ordinances. / �°
Building Inspector
NOTICE:
This permit doea not cover 1he construNion, inalallaHon for wiring, plumbing, gas healing, sewer o� wate�. Be sure 10 see
the Building Inspector for separate permifs for these hems.
4
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Owners Name
' APPLICATION FOR HUILDII+TG PERNlIT
, CITY OF FRIDLEY, MINNESOTA.
�aT888 _ aacuea���_.� ..-..�.� _�.�
� LQCATION OF B ILDING
No.�,,,,,��� � Street �(%��o�� �, Part of Lot �� L
iv �� ��`'cJ
I�t Block Additi�x �rfSuti.� . -
- p- �
Corner Lot In��,de Lot�Set Ba.ck �� Side-Yard ���' �_,....._
SEWER ELEVATION FOUNDATION ELEVATIOAT�,�_
Applicant atte,eh to this form Certificate of Survey of Lot and proposed buildin�
location. - - - - - - - - -
DESCRIPTION OF HUILDING
To be used as:
r v, �► ' ��
�ont Depth He3ght— �,�_
Sq. Ft. ��, � • F't. , n �
p � � �ry
Sq. Ft.��_L...��. Ft. ..._
�
Type of
Cost „_._!
Ts be completed ' � .
The uhdersigned herebq makes appl3cation for a permit for the �rork herein specified, "
agree3ng to do a7.1 work in strict accordance with the City Ordinances and i'u13ng of .
the Department of Bui7.dings, and hereby declaxes that all tY�e facts and representa-
tions stated in thia application are true and correct.
DATE 5IGI�ATURE
-
(A Schedule o� Fee costa can be fourid on the Rsversa Side.)
� _, ,-''�
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BIIILDING PERMIT FEE SCHEDULE
Section 2. The Inspector of Buildinga sha31, '15�fore issuing�arry��per��.t
for the erection of an�r bu3.lding or structurey or for any addition.to
any existi.n� building or atructure, or for any alterations or repairs~,
to any existing building or structure, upon applica.tion therefor, requir.,��
the pa3nnent by the applicant for such permit of fees to the amount here�.n.
below set forth and in the manaer h�rein p"rov3deci`�o-wi�:
2.1. For any such permit for the erection of any fire-proof bui].ding, other
than a gsrage, warehouse, factory or grain elevator, or for the erection of.
any fireproof addition, for similar occupancy, to any existing 1aiildin� �
shall be at the rate of �1.40 for e�.ch one thousand cubic feet, or fraction
thereof, in suQh cubical contents.
2.2. For any such permit for the erectiots of any fireproof garage, were�
hous�, factory or grain elevator,�or for the erection of any fireproof
addition for s9milar occupancy, to any exist3ng building shall be at the
rate of �1.25 for each one thousand cubic feet, classifie@ as "f3reproof'�
by Section 502 of the Minneapolis Building Code.
HO�ES
- �. J-• `F�' a� . st�-Perm�-�--€or the- e�tiur� of �crry- non-firepraof -�ui�dirig- -_ — —
other than e, garage� warehouae, factory or grain elev�,tor, or any non-
fireproof addition, for aimil,ar occupancy� to any exist3ng building.
Permit $1.00 fox each one thousand cubic feet.
GARAGES
2.4. For any sv.ch permit for the erection of any non-fireproof garage,
warehouse� factory or grain elevator, or for the erection of any non-
fireproof addition, fox similar occupancy� to any exiating building
for each such building or addition. N3nety Cents for each.one thous�d
cubic feet or fra,ction thereof, in the cubical contents thereof with a
mir�imnm of �,fw00,
For the pw�pose of computing fees for building permi.ts the cubical contents
of any building or addition to a uniform height throughout by multiply3ng
the grouz�d axea conered fr_s�m a�aoin�- �.:- ���T-��s-��w the -i�vrsr Iin� of
� the basement or cellar to the average height of the upper surface or to th�
average height of the roof surface of the main gable of a pitahed roof.
2.5. For repairs or alterations to an existing structure, the fee shail be
at the rate of �3.00 for each Five Hundred DoLi.a�� (�500.00), or i`raction
thereof in the coat of all proposed work.
2.6. In no case sha11 the fee charged %r any permit as set fort� in
Section 2 6e less than �4.00.
,o—•. ..e_� �. �
/'� � ..
- . ' Lo-rs t3 � 14, �LOC�c. 3
�_� M 000.E LAKE H I LLS .�NOKA COVI�ITY
NW Cor.
Lo f 13
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NW Cor:
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Lot 14
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L� !3 ti 36.2• a 43.e' <Lof l4
o� ' ' • . . ¢ 80 ' • ' ��,
HILLCREST ORIVE
SGO/6 - / n = � �
I, hereby, cerfi{� thaf fh� obove plo� is o f�ue ond correc� copy o�o survey of
'• jhiof port of Lof �3, !y inq Eosf of o/ine exfending ��orn fhe .Southeos�c�,^nc�r�f s4id Lo f/3,
to opoi�f on the No�h /ine of said Lof, disfonf 60feef �as� {�orn �he,1/OrfhWPSf �orne�
o{soid Lo�, fogether with thot porf of Lot /4, /ying Wesf of v/in� exfer.din9 {rorn fhe
5oufheosf cor�e� of Lof 1.�, fo o poinf on the North /i�e ofLof /�, disfonf 2D;�erf Eos�
{rom th� IVorth wesf cornPr o�Lof /� , o// in �lock 3; /�/Ioo,Nz �oke /�i //s ,''os survey�d by
rne this 22nd doy of Morch �7. D/960.
. ,�. ned � � � `' '
,` 9 Req i sfei ed Ci vi / Engin�ei^ Q` LondSurveyo� - No, 9�0
SUBJECT P O.
City of Fridley 214 6 2
' , AT THE TOP OF THE TWINS g � I L D I N G P E R M i T I�
r
� �
� ; y __�__ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. �I y% 3�
`� _ �
..-_� �/"�;•, CITY HALL FFIDLE� 55432 NUMBER REV DATE PAGE OF APPROVEO BV
i 612-571-3450 910-Ft 5 ��2 ��92 � �
JOB ADDRESS 1350 Iiillcrest Drive NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. �. 13,14 3 Moore Lake Hills SHEET
2 PROPEiiTY OWNER MAIL AODFiESS 21P PHONE
Peter Meyerhof� 135� Hil c 571- 4
3 CONTqACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
D& D Home Improvement 7401 Central Ave NE Fridle 55432 7- 4840
d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Ii2S 1 C12Y1't13�.
7 CLASS OF WORK
❑ NEW � ADDITION ❑ ALTERATION �7 REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroo� House & Gara�e (21 Squaxes� Tear--off
9 CHANOE OF USE FROM TO
STIPULATIONS
Underl�rznent uiust comply with the State Building Code.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED 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 COMMENCEO. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1' STALLS GAFAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SUFiTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILI BE COMPLIEO $1 113 $.56
WITH WHETHER SPECIFIED HEREIN OR NOT. TME GRANTING OF A PERMIT �
DOES NOT PfiESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUC O OR THE PERFORMANCE OF CONSTRUCTION. 529. OO Fire SC $1. �.�.
PLAN CHECK FEE TOTAL FEE
License SC $5.00 $35.67
SIGNATUR O A ORORAUTNORIZEDAGENT IDATEI EN OP Y ALI AT THIS IS YOUR PERMIT
SiGNATUREOFOWNER�iFOWNERBUILDER� IOATEI LOG INSP �s���ATEa �
`�:.,�
NEw �C l �
ADDN [ ] CITY OF FRIDLEY
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Applicatioa
Cons°truction
� �n!
Effective 3/1/92
Owner Name 8c Addr�: ���L!���1��I� � Tel. ����. O��
Coutractor: D& D Home Improvement, Inc. MN LICENSE 1� 4840
Address: 7401 Central Avenue N.E., Fridley, MN 55432 Tel. �t 784-7543
Attach to this application, a Certifific�te of Survey of the
lot, with the proposed constiuction drawn on it to scale.
DESCRIPTION OF IMPROYEMENT
LIVING AREA: Lengt6 _„_ Width Height
GARAGB AREA: LEngth Width Height
DECK AREA: Length Width HgtiGround
C�y � : ;
Sq. Ft.
Sq. Ft,
Sq. Ft.
Corner Lot [] Inside Lot [] F� Yd Setback Side Yard Sexbacks
Type of Constivction: %°-�- 9� %-��'�i�' �e P.stitnated Cost: S ��/�
App�R. comptetion nate: ��s� `�` ,9��'�� �I ��
��� ��� 1��� (Cost on Back)
Driveway Curb Cut Widtb Needed: Ft. + b Ft = Ft x$ _$
DATE: APPLICANT: t���
Permit Fee $ � �0° G� ��
Fire 5urch�ge $ (, / 0
State Surcharge $ � �
SAC Charge $
License Surcharge $ � � C`' C�
Drivevvay Escrow $
Park 'F� $
Sewer Main Charge $
TOTAL
STIPULATIONS:
$ ��� �'7
' � �L_
Tel. �
Fe,e Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$700 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
Fee Determined by Engin�ring
Agreemem N��r}► i l N� . N��Y I J
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BUILDIN(i PERMIT FEE SCHEDULE
Th� Chief Bailding Official shall, before issuing permit� for the erection of ai►y building or struchire,
or for any addition to any existing building or struct�e, or for any alteration or repair to a�r existing
building or stntcbn�e, u�n application therefore, require the paymeirt by the applicant for such permit
of fee.c to the amrnmt herein below set forth and in the manner herein provided- to-wit
TOTAI. VALUE
$1 to $500
$501 to $2,000
�"1,001 to �25,000
$25,001 in $50,000
�550,001 bo $100,000
�100,001 to $500,000
�SOO,QOI to $1,000,000
$1,000,001 and up
FEES
$15: (Minimum Fee is $15 plus surcharge)
$15 for first $500 plus $2 for each additional $100 or
fraction thereof, to and including $2,000
$45 for fitst $2,000 plus $9 for each additional $1,000
or fraction t�ereof, to and including $ZS,000
$252 for first $25,000 plus $6.50 for each additional $1,000
or fraction thereof, to and including $50,000
$414.50 for fust �50,000 plus $4.50 for acb additional
$1,000 or fraction thereof, to and including $100,000
$639.50 for first $100,000 plus $3.50 for each additional
$1,000 or fraction thereof, to and including $500,000
$2039.50 for the first $500,000 plus $3 for each additional
$1,000 or fraetion ffiereof, to and including $1,000,000 _
�-�
$3539.50 for the firse $1,000,000 plus $2 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROVf/
(Concrete (,�irb Sireets Only)
Alteinate "A" : Removal and repla.cemeut of curb and gutter only - Driveway width plus 6 feet times
$13.50.
Alternate "B" : Removal and replacement of cutb 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 houis from the time of applicatioa to allow
for proper review of the proposed structure and of the constivction site.
A Ceitificate of Survey of the lot, showing the l�on of the fouadation once it has it has been
constructed will be t�uired before proceeding with the framing.
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SuB�Eti
City of Fridley
AT THE TOP OF TME TWINS g � I L D I N G P E R M I T
i •
� �
� `V __��_ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
1 . �
� ` �"'1 � CITY HALL FRIOLE� SS132 NUMBER Aev DATE
�'""'� � �'' 612-571-3450 9�ap�5 3/12/99
JOB ADORESS 1350 HILLCREST DRIVE NE
1 IEGA� �OT NO. BLOCK TRACT Oii ADOITION
DESCR. Pt 13,14 3 Moore Lake Hills
� PROPERTY OWNER MAIL ADDRESS 21P
/
29003
�.
( � /�
OF AVPROVED BY
�
SEE ATTACHED
Sh1EET
Peter/Rose Meyerhoff 1350 Hillcrest Drive NE 571-0254
3 CONTRACTOR MAII ADORESS 2IP PNONE LICENSE NO
Roof Design Partners LLC 4026 7 St NE, Columbia Heights MN 55421 789-6566
1 ARCHITECT OR DESIGNER MAII ADORESS ZIP PMONE LICENSE NO.
20004817
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WOFiK
O NEW O ADOITION O ALTERATION C� FiEPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof House & Garage (25 Sq) Tear-off
9 CHANOE OF USE FROM
TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST
SEPARATE PERMI7S AFiE FEOUIREO FOR ELECTRICAL, PLUMBING, NEATING.
VENTILATING OR AIR CONOITIONING
TMIS PERMIT BECOMES NULL AND V010 IF WORK OR CONSTRUCTION 20NING
AUTHOR12ED IS NOT COMMENCED WITHIN 80 DAYS, OR If CONSTRUCTIpN
OR WORK IS SUSPENDEO OR ABANOONEO fOfi A PERI00 OF 120 pqYS AT
ANV TIME AFTER WORK IS COMMENCEO. NO. DWLG. UN
I MEREBV CERTIFY TNAT I MAVE READ AND EJ(AMINEO TMIS APPLICA710N 1
ANO KNOW TME SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS yALUATION
ANO ORDINANCES GOVERNING TNIS TYPE OF WORK WIL� BE COMPLIEO
WITH WMETMEii SPECIFIEO HEREIN OR NOT. THE GRANTING OF A PERMIT �2 s 142
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTHER 57ATE OFi LOCAL lAW REGULATING CON- @74.75
STRUCTION Op THE PERfORMANCE OF CONSTRUCTION 4�
'� PLAN CMECK FE
�J� �'�v�.� Licens
UAE O� CON'AACTOA Op AUTNOpIZEO pGENi IOAiE� EN I
OGCUPANCYGROUP OCCUPANCYLOAD
SO.FT CU FT.
OfFSTFiEET PARKING
STALLS GARAGES
SUR7AX
�1.�7
SAC CH E
Fir C $2.14
TOT L F E
$5 2.96
ALI THIS �UR P�RM�
� �
rrEw [ ]
ADDN [ ]
ALTER [ ]
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/98
�
� �\�
ConstructionAddress: � a�� ��� e S-� Y- i
Legal Description:
Owner Name & Address:
Contractor:
Address:
-' Tel. # � r] � ' �j y
MN LICENSE # ��� � R�'%
,�S_�Tel. # ��
Attach to this application, a Certificate of �urvey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
LIVING AREA: Length Width Height
GARAGE AREA: Length Width Height
DECK AREA: Length Width Hgt/Ground
OTHER: � � / �j
Sq. Ft.
Sq. Ft.
5q. Ft.
Construction Type:�p� f�� A}- r�_ Y�.� Estimated Cost: $ ,, o �/ ��
Y���� � ��� � • (Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: - APPLICANT: Tel. # ��- �p 5Lp �p
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �` . ��5�
$ �. !
$ .C�`%
$
$ S O�
$
$
$
$
$ ,9�
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Pemvt Valuation (1/lOth%)
$.50/$1,000 Valuation
$1000 per SAC Unit
$5. QO (Sta.te 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 O�cial 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 pernut 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
$100,001 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 additiona.l
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $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, OUO
$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)
Altemate "A": R�moval 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 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.
__ � �
CITYOF
FR[DLEY
FRIDLEY MUNICIPAL CENTER • 6431 LTNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
August 8, 2001 PWO1-044
Mr. Hans P. Meyerho�
1350 Hillcrest Drive
Fridley MN 55432
Subject: Driveway
Dear Mr. Meyerhoff:
As per your request, I stopped by your residence to look at your driveway. I observed that the
compacted thickness of your bituminous driveway ranged from approximately 1 inch to 2 inches
witt� an overall average of 1.5 inches. I measured eight locations across the sawcut edge of your
driveway. Please refer to the attached sheet for a sketch of lacation and thickness.
The City will be replacing part of your cixiveway to match the new concrete curb being installed.
The new driveway area will have a compacted depth of 2 inches of bituminous and 6 inches of
Class 5 aggregate base.
If you have any questions, I can be reached at 763-572-3551.
Sincerely,
: �%�,�d .
Layne Otteson
Assistant Public Works Director
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THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNiNG APPLIANCES OR THE
APPUCATION WILL BE RETURNED
•iiii•► / ► / ► •►► •: �►� •ii: •► _ : / : ! �•►
When :� �a��nQ, an _Yic+in0 �ran __, 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 plasticJPVC 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 is a listed assembly
and meets the current codes and manufacturers specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
'me eYi�ng �emh�,�en a�r is sized and installed to meet the current codes
and manufacturers specifications.
WI1@n �2qUl�d t0 �^�a�� a n_w _emh �etien air� it will be si�ed and installed
to meet the current codes and manufacturers specifications.
�gn jp�jJjpO a new ver�tinQ�y�, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
sper,ifications. This does inGude AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances.
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 ( )
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
Yes( )No( )
�.. .�.,- .- .�. - .����.. -� .�. -� .�.-«. � ..��. .�
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 w
1 - �•► �- .•,-
HEATING CO:
Signed By: Date :
f
��.
DATE: L?ecember ] l, 2003
TO: Fridley City Goimcy7
FROM: Pete�r & Rase Meyer�roff
1350 Hi�lcrest Drive �iE
Fridley, M�I 55432
TeL 763-S7i-OZS�4
SUBJECT: RID OAK WILT WARI�7ING NOTICE
� ' \`� ( � ,/ /
,�,�1 � � � � ,,
�
On August 3, �Q03, the Fridley Tree Inspector hang a Tree Inspection repart (see
attached) on our door, s�ing that w� must remo�re a diseased oak tre� 510� aa back
yazd We coMacied an i�t arborist Mazk St�es (763-253-00��. Mark cam�
to our house aad confirmed d�at dzis �+ed oak ind ind�ed died of osk �1t. He offered to
inject the roats af my nearby health3r red oak to �event it fronn geuing infec�+ed as �ell
(via root graft). I was gtad to pay $3�0_- for this injection to save a tree (Augu�t 7, 2003).
I spoke to two of my adjaceat n�aghbo�, Elirrabeth VVerner aad Steven Gilm�_ They
said that they also had wi}ted red aals removed from their p�upe�t}� last �ear amd the �ear
before. The City's Tree Inspedor cond+em�od their trees as �aicelt BUT FAII.ED TO
NOTIFY TI� NEIGHBQRS THAT, AT THEIR OP i10N, TI�Y MIGHT �AVE
TE�IR TREES BY TE� IlyTECTIOI�i PROCESS.
We ended �p paying $1,360.- to remove oar tree and comply with the Cit� lnspoct�'s
request. The tree and the remowd! expe�nse could have been saved � TF� CTTS� H�D
NOTIFIED US OF THE PROBLEM Wl�N 7T�Y NOTIFIED OUR NEIGHBOR�.
Please order your Insp�ector in wTiting (send ns a copy� to AfOT1FY A�IYOI�iE WHO
OWNS A HEALTHY RED OAK TREE WrC�iV1 �►100 FOUT R�1DIi7S OF A
WII.TED RED OAK so that, at their optioq thcy may be able to pru�ct th�r �
tree by having it injected (� guarantees).
We consuited on this writh Je�y Juzw9ick (651-649-S1 l4) USDA Fare� Servioe and
Professor at the Universiiy of M'innesata.
Respectfully submitted,
�. �
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_ .� - FRIDI.EY� .
�M� � P���� � ��2►�5
6431 UMVERSTTYAVE. N.E. • FRIDLEY, MN 55432 �
_ - _ PIiONE�j572-3566 �ij—i3 P
'-� � TREE INSPECTION REPORT:
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CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
C� �-� -��.. a.
PERNIIT NO�� 2,� _00753 . %
DATE ISSUED: OS/20/2004
763) 572-3604 FAX: (763) 571-1287�
ADDRESS : 1350 HII,LCREST DR NE
PIN : 243024120035
LEGAL DESC : UNAVAII.ABLE
: LOT BLOCK
PERMTT TYPE : BUII.,DING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : DECK
VALUATION : $ 745.00
NOTE: SEE NOTATIONS ON PLAN.
CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. CONSTRUCT A 10' X 6' DECK.
STATE LICENSED CONTRACTOR 1
APPLICANi BUII.,DING PERMIT FEE 32.65
CULBERTSON T CONTRACTING 20440821 PLAN CHECK FEE 21.22
1358 HII.,LCREST DR FIRE SURCHARGE 0.75
FRIDLEY, MN 55432 STATE SURCHARGE, VALUE 0.50
LICENSE SURCHARGE 5.00
TOTAL 60.12
OWNER
MEYERHOFF HANS P & ROSE
1350 HILLCREST DR NE
FRIDLEY, NIN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or const�uction
authorized is not commenced witin 60 days or if constcuction
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
application and lmow the same to be true and correct. All
provisions of laws and ordinances governing this type of work
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
regul�ig� nstructi • e perf +�aace of co 'on.
1�pplicant Date
Bldg Ins Da�j � "
SEPARATE PERNIITS REQUIRED FOR WORICOTI�R THAN DESCRIBED ABOVE.
NE1N [ ]
ADDN []
ALTER ( ]
Construction Address:
CITY OF FRIDLEY Effective 4/1/2004
6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 � d n
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (76�571-128
BUILDING PERMIT APPLICATION � �'�
~���, �--� ����' � � , ,�
� �
�-, ► Ic���- D� ���I�� � �sy�32 �
Legal Description:
Owner Name 8� Address: �e�-p.f' �ec�� Tei. #�76� --v�7/ 1 d25��
Contractor. ��� e�, � b�e�� MN LICENSE #�f�`/�/08� 1
Address: f��i � I� 1� Gr� �- or ���j d"Ie. ���°7_ Tel. #� � 2- 7��8Z �
Attach to this application, a Certificate of Survey of the
bt, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LMNG AREA: Length Width Height Sq. Ft
GARAGE AREA: Length Width Height Sq. F�
DECK AREA: Length l �� Width 6` Hgt/Ground ✓, Sq. Ft � D
OTHER: �
�(JUOa � �l P� o ,� �� �7-�1�. �-C�
Construction Type: -�� � k` "'Estimated Cost: a I� D(�� �v
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
DATE: 5 APPLICANT: ��t.�l�,�Ka� Tel. # 6�2 -73i -�16�
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. '
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
CITY USE ONLY -
$�. Fee Schedule on Reverse Side
$ c� � a� 65% of Permit Fee
$ � `��� .001 of Permit Valuation (1/10th%)
$ s ,,�� $.50/$1,000 Valuation
$ $1350 per SAC Unit
$ � � OC� $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 [ ]
$ � D � I � STIPULATIONS:
_/ i
BUII.DING PERMIT FEE SCHEDULE
The Cluef 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 alteradon 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 tawit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,�1 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,�1 to $500,000
$500,001 to $1,000,000
$1,Oa0,001 and up
FEES
$23.50
$23.50 for first $5� plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.(� 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 fracdon thereof, to and including $100,0�
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to 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,OQ0,000
$5,608.75 for the first $1,000,000 plus $3.15 for each addidonal
$1,000 or fraction thereof
CURB CUT ESCROW
(Concrete G�rb 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 foundadon will be required before
proceeding with the framing. New Houses Onlv
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C���
NUU-�7-2005 14�48 CITY �F FRIDLEY
P.02iO4
Bt1l�dlrig ��'�'I�� Permit No,: -C�0 ��
�a,spectians �SY�ENTIAL A.�,'�'LICATI�� R�zV�
-
?. 63-572-3604 �I�X' �� FRIDLE'�' �a� R� :
DAT& �P '�� - � % � � YOUR &MAlL ADDRESS
S17'E ADDRES5 �
TI�IIS APPLICAN7IS:
O�VIVER/
TENANT
��iIN' . �1! � :
❑ OWNER �ONiRAC'l�OR
a,nDxESS: o.�i� �/; �rcr�s°�- �:
PHPTIE:_�G�.� °.� �/ ����;��
w• r
SL3BMIT A COPY OF �rAGT PERSOTI:��2 /� �c° i' � i E%7e" //�'
YOUR STATE STATE 11CQ�T5E � D�' DATE
LiCENSE WIT�I .�n�RFSS��,:,'� n�� �r ,�.� � cmr�'L,�-�-h ��-GG� � srAr�i2.� z��/c� �
APPLICATlON PiIONE�t7,-S/-.J4�-.�a���-y FAXI,,' 5,��- � ��7�
. G, 3L'r-� � �`�...., .� ._..,._,
PERMI'P'�XpE
r�E oF wa�c:
�SIIVGLE FM�IIL'Y O TWO FAMILY O TOWNHOUSfi
�NEW . ❑ REPLACEb+�N7' �i�LTEEtATiON/REMOD�I�.
DETAII,ED DESCRII�'ITON OF WORK ��S i� /
---- -'— - — -
PER MS 16B.655 the permit fea Is a minimum of SXS.OA or 5% of ihe total cost op to $500.00� whiohever i5 gtoa2a�, for the
impr4vcraent, instailation or replacement of a aeside�ataal fixture, excluding the fixtures. (Thls shculd reflect only the cost of labor )
L,abot cost �mder $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS C
FOR PROJECfS V�RL' LA$pR EXCEEDS $504, FB�S ARE BASED ON $10,00 PER FIXTURE, EXCEPT � 1�i0�E1?. kIX7VRES: (II�IDICATS TOT�U.
rrvr���t o� �►c�1 eEt.aw�
EqutpmcM Installed , MFG: aI �� il MODEL; +����✓� 51ZEJBTU
IvIFG: c. / � MODEL: •' o/s% SIZE/BTU
MFG: MODEL: 51ZF1BTU
^ac $zs.� qZ �FIIi�PLACE (GAS) $35.00 aas xfwG�ov� s�o.00 - -
AIR TQ AIR FXCilA1JG�ER $15 FIREPI..ACE (WOOD) �35.� NEW GAS QRA�L 510.00
�,BOII,ER S35.Q0 _fiURI�1ACE $35.40 GAS UN17' H�'R S10.00
CHI1W�lEY L�ER �lO.OD f3AS DRYER S10.Q0 � POOL i�AT�R S3S.00
- ..�. - - - �.... --
Sttrchatg,e � -- .SQ - -N�6ber<a��{c�$�3-8@-- - �-$1;5 00� -
TOTA.L DCTE $ .�v .� Number o�5oeqves � $Z5.00 X $25.00 � $
Nuwber of 8�ttutes (q� $35.00 x�5.00 n�
State SurCharge = $ , .SQ
Tota1= �
i1�S IS AN APPLICAT1CiN FOR A, P$RN9T NOT VALID 17NT1`Q. PROGFSSID
I hereby spply for s bwldmg pe�mit and I acl.aaow�edffie t�at the informatiot� abovo is camplete a�ad �aw�ate; that the work wt7i be in
conformance with the otdfiaaaces and codes of the Clty of �ridley �nd with the Minnesota �CoASevction Codes; that I uAderstand this is
not a permfc but only an applic�iaou for a permit aad work is not to start witliout a peznnit; that ibe work will be ia acc�rdance with th�
approved pian in the case of aU work which r uires review an�d approval of plans.
SIGNATURE OF APPLt � '� � p�' N,4ME� �'! co �j n DATE� ���
�1'kj� O� �C�i��6�
��nilding Inspect�ons Department
6431 Un�versity Avenue NE, Fridley, MN 55432
763-572-3604