AF - 46675City of Fridley
AT THE TOP OF THE TWINS
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� • COMMUNITY DEVELOPMENT DIV.
� j L �������
� � PROTECTIVE INSPECTION SEC.
1 � �
� i"'1 � CITY HALL FRIDLE� 55432
1•��'� � ,•� 612-580-3454
SUBJECT
BU ILDING PERMIT
NUMBER REV. DATE PAGE OF
910-F15 7/25/77 � �
JOB ADDRESS 1291 Hill Wind Road N.E.
1 LEGAL LOT N0. BLOCK TRACT OR ADDITION
DESCR. EB,St �.00 � Of IA't 2� A11C1. S'UI?. #94
2 PROPERTY OWNER MAIL ADDRESS
David Betcher
3 CONTRACTOR MAILADDRESS
Gary M. Gorh$m Construction 905Q Collins Drive, Anoka
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAIL ADDRESS
8 USE OF BUILDING
Residential
7 CLASS OF WORK
X NEW
ZIP
ZIP
ZIP
ZIP
� 14235
RECEIPT N
i%���G
APPROVED BY
SEE ATTACHED
SHEET
PHONE LICENSE NO.
421-0998
PHONE LICENSE NO.
PHONE LICENSE NO.
❑ ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Construct a 68' x 44' �velling and a 24' x 24' Garage
SEPERA�T� PERMiTS REt�U�REa FQR i�VtR�we
9 CHANGE QF USE FROM uc ����, �% ����� aN� TJIG�Ss
�i{./� • �
STIPULATIONS Provide a ha.rd surface driveHray. Provide a verifying survey before
capping. Provide sod in i•he front and side yards. Provide louvered d�r or
window in utility area. Provide exhaust fan for utility area. if window not
installed.
SEWER LOCATION: (Approx. 13' Deep Inc].uding riser) 37' West of Manhole (Inv. 952.54)
WYE ELEV: 952.69 + 3.00 Riser = 955.69 TOP OF FOOTING 959.19 Minunum
WATER LOC�,TION: 13' West of Sewer Service 51' N.W. of Ma.nhole
DRIVEWAY DEPRESSION COST: N/A Existing Bit. Curbing. ��'��
7'HE CITY OF F�IDLEY pOES NOT GUARANTEE TME ��� �j Ut11�t�ES
O�CCURACY 4� tJtIUtY LOCATIONS AND EL�VVAitGP:g. Before di�in8
�� :� DnrA rs FOR i��O�tiON Pu�os�s o�+�Y �n�3 iELEPNO�a� •�tEC�RiC • GAS Etc.
FE2SONS U�NG IT SHOULD YEIHFY tNi INFpRAAA'ilph ��Q�IR�p gY i���dy
ON iHE SfTE
TYPE OFCONST. OCCUPANCY GROUP OCCUPANCYLOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOCl FLdICU
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING
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 COMMENCED. NO. DWLG. UNI1
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING T#iIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $46,410
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE
PROVISIONS OF ANY OTHER STATE OR LOGAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. S�-4�-.76
PLAN CHECK FEI
� �� -�%�
SO.
STALLS
,�''� � �✓ �� � ` � $ 3 5 . 44
SIGNATUREOF ONTRACTORORAUTHORIZEDAGENT IDATEI � WHEN PR�PEI
� �y C.� � � '`F---'K B `
CU. FT.
76 35 440
JFFSTfiEET PARKING
IGARAGES
SURTAX
$23.20
SAC CHARGE
$375.00
TOTALFEE
$573.40
D THIS IS YOUR PERMIT
7 -� � -`7
6ERALD T. COYI�
30D BRIiNSN/I�i4 AV@ S.
6OLD�d VALI.EY. MINN.
MINN. REG, NO. �74!
iNau�a��. -- �uaicuu.
cot��ottiwi. — TOPQ(�RAPHICAL
CI'fY IOTS — PLATfINC
30RHAM C QN STRtlC'T I ON
!!iT SUl�1/EY�S C�A�ifY '��";' a � „�"�"
�D 8����� BROOKLYN PARK, MINN.
MINN. REG. PIO. 6T43
�'�D Ol�i 6►n OD 61'�i'� (� IUDIliBYdT� �� ��
Ltca��sp � oaoII��iCS o� f�rY os f�xi�►�Lts IN1A01l� NO
57�7 W. BroadreY 5�3-992i F. �. N�.
blinas�spolii, Mianesote S54Y8 �� �a � �� �
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Lot 2, Auditc+r's Subdiv3.5 ° a►
No. 9k, A�ok� C4unty,
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3�URYEYB COD�PiA1�T7�
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CITY Of= f=j�I]�:.L'f , , �
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' APPI_ICI�TIOf�1 FOR RESIllC�'TIAL LUILDING PERI�7ITS �
( rJ���, �LTL= it/1T I GPJS, nDD I T I U(d�, UR RE PA I RS )
OP;tJL•'R: �'�,�� r,:� ,�c ���1 r� PuILUL•'It: '�i c� '- .� � �r�.,� ,�
Address: Address: ;�.�� ��%��«„� �E_ �ne�''.,,.
Tel . Np . '�� �/` - <�� ��'
,II �����"� ,
Na. ; � � � � Street :
7�OT• BIACY.: ADDITIO� r���„ /,/�. �l'=f
COI2IIER LOT: I2�SIDE LOT: � SETBACK: ���� SID�YARDS: �'? r
Applicant attach 'to this form �ao Certiiicates of Survey of Lot and proposed -
building location drawn on these Certificates. '
DESCRI PTION OF BUI LDI NG -�
To Be Used As:
P y r
; •.v� r .>R , �,�. Front: � .� Depth: ��`� Height: �S°
-�--- -
Square Feet: _!���Cu c Feet: � f �o ��
� ��
- ��nt: �°� Depth: � Height:
� Square Feet: � � �C'(ibic Feet: � � � �
Estimated Cost�$ ��•�----
Type of Construction : I,� � ti � ��� ��.. ^-
�'� � d , �
7.b Be Completed: /? -- °v' -�� Alt. A� Alt. B
s
Proposed Driveway Width If New Opening Is Desired �'� $ $
(SEE REVERSE SIDE OF SHEET)
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct. See reverse side for additional information.
DATE: 7°/u -�7 SIGNATURE: ,,J �`'�'�' �-�'°'/�
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Stipulataons:
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LSUII_1J11'�C7 I'::tr;'{; 1 :jGC 7l.11f_UULt_
SECTJOI•d ?.. 'Phe I»sF�c.ctor o£ I:ui_lcli.�,ys: ::hall, k,c.fe�rc� ��;suiny {."'��n:it�s i'or 211e r_�recLic7i�
C�f i111�1 }�U)�.(�I:1iJ (�1" 1�i:L�UC:t.;;f.(•� r�l" 1C)7.' �:llj� �1(��il�'.JCiT'i !C� l�lll� l'i:l';tilil�J ��121.�_(a1:1'f bY :_tYll!:il1Yt'o
c�r ivr rairy ril.��_�r.iLicin or. r.c�prxir.:; lo air, �: i:;l.inc3 l�u�J.c;i.nc� c,r :�iru<.tur.e, u�,uri aJ�}�]i�::,�t-ics:�
thr_r.ef.ur.�, rcc�uir.e ttie 1}ay�nc:�r�t 1�� tl,e �,Flj,li.�•:���� Z:ur sur.:i j.urm_iL of f:ces to Lhe an�utzt�t
hcr.c�ir, }�clow sci L�rLt� atiu in L}�c rna.i�,�.n c���ei.n F%r.oviuccl tu-wiL-:
?.i.�•J CUII�TRUCTIOtd: Sin�31c P'�mi�.;� Flom��s anii Gar.ages: $4.00/.l,UUU cubiC fcet-.
PLI�Id CIII:CY.: 25 I�crcent of. }�uilding t�crin�.t ice.
DR?VLt�7AY llEPRI:SS]:UI1: (Cvncrci:r� Curb Str_cet� Only)
Altcriir�i_� T,: Remov<il anci ri���lt3cement of concrete curb and
gutter only; Uriveway width j�lus 6 feet x$11.75
Altrrnate B: Rcrnoval and re��lac��ment of concrete cur.b and
gutter and install a 3 fc�ot wide approach with
F, inch depth; Lrivcway width plus 6 fec� x; l�.y��
ADDI T IOP,AL I f�F�'•1AT I ON
For the purpose of computing fees for building permits, the cubical contents of any
building or addition, is determined by r.?ultiplying the ground area covered from a
point sir. (6) inches below the floor Zine of the base,-nent or the cellar to the
average heigr.ts of the upper surface or to the average height of the roof surface
of the main gable of a pitched roof.
For repairs or alterations to ar_ existing structure, the fee shall be at the rate
of $3.00 ner each five hundred dollars ($5a0.00) or fract?on thereof in the cost
of all proposed work.
In no case shall the fee char�ed for any permit as set forth in Section 2 be less
than $7.50 plus $.50 state surcliarge.
. �(ERIFICATION OF FOUNDATIQ(�
NaTE: Perm�_ts �or construction will be issued a minimum of 24 hours from the ti.me
of application to allow for proper revie�a of the proposed structure and of the
construction site.
A Certificate of Survey of the Zot, sho�ving the location of the foundation once it
has been constructea will be required before p�oc�edir,g with the framing.
CtRTIFICATE OF OCCUPANCY
Application for a Certificate of Occugancy shall be made ten (1G) days prior to the
use or accupancy of any sti-ucture for which a buildang permit lias been issued; and
said struc;ture shall not be used or occupied until a Certificute of Occupancy has
been issued. �
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City of Fridley 2 9 8 4 8
AT TME TOP OF TME TWINS g U I L D I N G P E R M I T�
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; � RE O.
� `y _.���_ COMMUNITY OEVEIOPMENT OIV. '/� ^ �
r � � PtiOTECTIVE INSPECTION SEC. '�� 6�
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1 � /"'1 � CITY NALL FRIDLE� SS13P NUMB@ii REV D�TE PAGE Oi ApPROVED BY
�.---� • •,� 612-571-3450 910-Ft5
7/9/99 / /
JOB AODRESS 1291 Hi 11 ldi nd Road N
t LEGAL LOT NQ�' lOO � BIOCK TFiACT OR ADDITION SEE ATTACHED
oescR. Audi tor' s Subdi vi s i on 9� SNEET
� PiiOPEfiTY O E MAIL ADOR�S$ 21P PMONE
You - Chii Minh
3 CONTiiACTOR MAIL ADDRESS 21P PMONE LICENSE NO
Shin le Creek Const. 8108 415th St
4 AqCHITECT OR OESIGNER MAI� AOORESS ZIP PMONE LICENSE NO.
5 ENGINEER MAII ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION O ALTERATIpN X� REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Rero hou -
9 CHANCiE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Buildi�ng Code.
TVPE OF CONST. OCCUPANCY (�ROUP OCCUPANC� LOAO
SEPARATE PERMITS ARE REOUIREO fOR ELECTRICAL, PIUMB�NG. NEATING.
VENTILATING OR AIR CONOITIONING.
TNIS PERMIT BECOMES NULL AND VOID IF WORK Oii CONSTRUCTION 20NING SO. FT CU FT.
AUTHORIZEO IS NOT COMMENCED V�1ITNIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO fOR A PERIOD OF 120 DAYS A7
ANV TIME AFTEii WORK IS COMMENCED. NO DWIG. UNITS OFFSTREET PARKING
I HEREBY CEiiTIFV THAT 1 MAVE READ AND EXAMINEO THIS APPLICATION STA�LS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yp�UATION SURTAX
ANO ORDINANCES GOVEflNING THIS TYPE OF WQRK WI�L BE COMP�IEO $2709
WITH WHETHER SPECIFIED MEREIN OR NOT. TNE GRANTING OF A PERMIT �1.3rJ
DOES NOT PRESUME TO GiVE AUTMOFITY TO VIOLATE OR CANCEL TNE pEqMl7 fEE SAC CMARGE
PROVISIONS OF ANY OTMER STATE OR IOCAI lAW REGULATING CON-
STRUCTION OR THE PERFOAMANCE OF CONSTRUCTION �H3.2'rJ Fi re SC $2.71
� PLAN CHECK fEE TOTAL FEE
� � —� ' ense SC $5.00 92.31
�GN4TUA CON'AACTOpOAAUTNOp�ZED4GENT �04iEi WME pR PERLV VA IDATED THIS IS VOUR PERMIT
� /�-�
S�GNATU�7E O� OWNEp��f pwNEp BW�DEA� �O�TE� � BLOG �h5o �i�tE
�
�w [ l
ADDN
ALTER
Effective 5/10/99
[ ] CITY OF FRIDLEY
[] SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUII.DING PERNIIT APPLICATION
1��
�� ��
� ��
Construction Address: ,�,� � j �� � ( � � � � � .Q �
Legal Description:
Owner Name & Address: �C� c, - C�'� i VV1r►► ��� Tel. # G I�� S'3 �' � l 1$
Contractor: ��� �e C!' �e-e l� CC,� .� �- , MN LICENSE #� GU s G 6 3 g
Address:
LIVING AREA:
GARAGE AREA:
DECB AREA:
OTI�R:
_ `( ( ) ''I-1� 5'f'
� Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
DESCRIPTION OF IlVIPROVEMENT
Width Height Sq. Ft.
Width Height Sq. Ft.
Wic�th Hgt/Ground Sq. Ft.
r _
�
' v
�' � �- � �%9
Construction Type: �of� U�' �i�6 �3°� ���� S Estimated Cost: $ �
Driveway Curb Girt Width Needed: Ft. + 6 Ft = Ft x$
_$ . '
DATE: 7 - � APPLICANT: � !�-•- � Tel. # � 1 a '3 � 6 "/ 6 y `%
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �.� �s
� �. �/
$ �- .��
$
� .�.-D �
$
$
$
$
$ aJ �
CITY USE ONLY
Fee Schedule on Reverse Side
.(?Ol of Penmit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A° or Alt. "B" Above
$450.04 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
$50� to $2,000
$2,�1 to $25,000
$25,OOlto $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,0�
$1,000,001 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 additional $1,000
or fracrion thereof, to and including $25,000
$391.25 for first $25,O4U plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,0(�
$3,233.75 for the first $5(�,000 plus $4.75 for each additional
$1, 000 or fraction thereof, to and including $1, 000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additiona.l
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete C�ub Streets Only)
.Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERITICATION OF FOUNDATION
Pemuts 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 co�tructed will
be required before proceeding with the framing.
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�HIMNEY AND STACK VERIFICATION
The undersigned hereby verifes chat the existin� chimney or st�cl�:
�. kias been carefu�iy �x�mined Yes () No ()
2. Is free from rust �r dete�aoracior� Yes {) No (}
�. �ias no f�r�igr� ob�ects lod�ed vaitd�ie� Yes () No ()
4, Is securely supporced �es () No ()
5. 1�Ieets ali curr€r.t Code aequ�rements f�r si�e ,
and total �iU's connec�� 3fes () No ()
6 I�as total h�ating �i'i1's ��
AHt o�er �3Ti1's
TO�'AY. �'TLJ's
7• Has a liner been provided for water heater
�. �as cambustioa� aar been pr�vided for w�ter heater
Remarks:
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('�> � .A,
I,isC ALaERp►TIONS Being Y)one•
gIEATINC �O:
�ign�d �ye
Datea
Yes()No()
Yes()No()
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CITYOF
FR[DLEY
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FRIDLEY MLJNICIPAL CENTER • 6431 UMVERSTfY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
February 1, 2�2
Mr. Tom Kim
1291 Hillwind Road NE
Fridley, MN 55432
Re: Final Inspection at 1291 Hillwind Road NE
Contractor: Dave's Appliance Heating & Air
Dear Mr. Kim:
A mechanical permit was issued on August 10, 20(?0 to replace an "A" coil 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, no inspecrion has
been called for.
The pemut fee that was paid covers the inspection to make sure the work was
completed according to the Codes. We will keep your permit open for another 30
days and if we do not hear from you within this time to set up the inspection, we will
mark the permit "no inspection called for" and no further action will be ta.ken.
To set up the inspection or to have any questions answered, please contact the
Building Inspection Division at (763) 572-3604.
Sincerely,
/
,..!: /,r� ,.i _ �
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J�2�i/ �>/l�o�d /'�
THE BELOWaMUST BE FILLED IN WHEN REPLA�ING �`IJEL BURNING APPLIAhICES OR THE
APPUG'�TION WILL BE RETURNED
•u�i�� � I � •►► �•: �►� •1�� ���t � : I : •►
_
;' ._ When � �n acing an _�ric�ing;-f�rance, the undersigned her�by verifies that the :: .
�- venting has ;6een ex�rriined.�nct is free from rust, dete'rioration; obstructions, .'
and is securely supported.and firestopped wf�ere required. �� � Yes No ('�
_ . �� -
The venting system is plastiGPVC and meets all current codes and manufacturer
specifications including s'izing, len�, number of elbows and termination.
The unde�signed also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAl1�A Categary I Cen�al Fumace Venting Tables for fan
assisted and natural draft appliances.
The pY�e �e►„e���en a�r is sized and instalied to meet the current codes
and manufacturer's specifications. .
When required to in�an a n vu �me �etien air�,it wi1l be sized and installed
to meet the current codes and manufacturer's specifications.
When in�� a new ��ntine evc+ m, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufactwrer'�
specifications. This does ir�dude AGA-GAMA Category I Central Fumace
Ven6ng Tables fof 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 �j No ( )
Ye�� )11) �i
Yes `�c) No ( )
Yes ( ) No ( } � Fl
Yes�No( )
�! � • . � h' � ' . � � - • 11. 11 • � - � . 1 �• ' �1 • � / - M • � � L11 . • �
Appliance #1 Type _�.r �� � s- BTU Input g�� Fan Assisted or Nat �1 ��
Appliance #2 Type ����.c M.-E-� BTU Input � -o� Fan Assisted or Nat _ d�1 �--�-
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type ���n� Vent Height t� ti����iameter� inches
- Appliance #1 Vent Connector Height ,�,ft Length ,�ft Diameter �_in Type eJ ���
- Appliance #2 Vent Connector Height �ft Length �ft Diameter �in Type i��e�'�
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
A1 TFR,4TI(7I�S� (D e ri 1 _
HEATING CO:
Signed
�►t�o a �nt c��moNa�a uc
881-9000
• ��1- 7 9f`