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AF - 46323�^� �"'1 City of Fridley, Minn. BUILDING PERMIT �� 4 315 Da�: ..._./_'�__� _.�_� �..._�..._._.� .__.____. Owner: ..-----•--..._.........._....-------._....-•------_.........._.._._....�....._...._ .................... Builder ..��i��.�..._............._........._.---__......_........_.._._... Address.....-------___._...__.._._._.�_.. ._._.__._._ Address ......---.•--•��.-•-.---.---•-•-•--------._.. LOCATIO OF BUILDING ,�*� s � �� No. J...:��..�.�....... Street _.. �. . . . --- ---.. .,��----�.� Part of Lot ...��_r_.2.�'L.____.._....—. Lot ............�,� ............. Block ....._.........�.. Addition or Sub-Division �„��m�.._..'e��........-----.....•--..._..... Corner Lot ..........--�� ...................... Inside Lot ...._�................._........ Setback .�..�..�.....=.�._4........ Side3�erd �--.....�1''...�..-.:._Q.Y-�--.......---......_... 5ewer IIevation Foundation IIevation DESCRIPTION OF BUILDING To be u�a �: -• - -�-- •-��----.... Front --�--_`.-•-.--_.._.. Depth ....................__. Height ........................ Sq. F� ---��---....._...._.. Cu. F� ------g��--�--._...__.. .........� . . ......... .... .... Front .../....�...�...'��Depth ��..°��Height ,��.��"O Sq. Ft.3l...� Cu. F'� °.�l�J � . Type of Cons etion ............................... �----..................... Est. Cost.--- �� To be Completed ....._....---......_....--�---�•--� ...... ......_........ In consideration of the issuance to me of a perrnit to construct the building described above, I agree to do the ProPosed work in accordance with the desc�iption above set forth d compliance r sions of ordinances of the dty of Fridley, �/� /Jn „ ��j p� In consideration of the v w `'� ' payment of a fee of $...... ....'�, permit is hereb ........... Y granted to..-�---�--........-- ............._............._.-•--••--- ....._......_..._._._..._.....- ............._.........•-•----...---. to construct the building or addition as described above. This permit is granted u the express condition that the pOn person to whom it is grante�l and his agents, employees and workmen, in all �,nork done in, around and upon said building, or any part thereof, shall conform in all respeets to the o�� of Fridley, Minnesota regarding location, construction, alteration, maintettance, repair and moving of buildings wi'thin the ciL3' limits and this permit may i� revoked at any time upon violation of any of the provisions of said ordinances. Building Inspector PIOTICE: Thia permit does nef eover the wnslrueHon, installation �or wiring, plumbing, gas heatfne, sewer or wafea Be sure to see the Building Inspeelor for separafe permhs for fhese kems. ;,-;� Caity of Fridley, Mirm.. 6431 Univeraity Ave. N. E., Minneapolis, Minn. 55432 BUILDING PERM[T ��; October 25, 1972 py��; _ Randv .�ohnson , B�� Same �a�e 5224 Horizon Drive Ad�g Same �' .�� 7 �11760 LOCATION OF BUILDING No 5�_. Street Horizon Drive N,E, p� af �t Lot 13 _ Siock 1 Addition or Sut�-Division Summit Matlolc Cor�er Lot Inside Lot X Setback Sideyard �ewer IIeval3csn Foundal3on Elevation DESCRIPTION OF BUILDING To be vsed as: Enclose car uort �ont 15' �� 23' Height 10'''z sq, �, 345 �� 3795 Front Depth Iiei�ht Sq. F`t. _ Cu. F't. Type op Constructqon wood frame �� 891.40 To be Compieted 1 month ia con�tderai3oa of the issuance to me of a permit to ct the b ding des above, I agree ta dp the� Pr�d work in accordance with the dest�ipi3on abo ¢� se forth 11 �� ph�with all provisions oY Ord�anoes oP the dty of Fridley. \ �v In consideration of the payment of a fee o�$ 6•80 , permit is hereby granted�o Ranav John.son to construct the building or addition as descrlbed above. This permit is granted u�wA 'the eupress condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in ai( respects •to the ordinances pg Fr3dley, Minnesota. regarding location, construction, altera.tion, maintenance, repair and moving of buildiuga �� 'EY 7imits and this permit xnay be revoked a t any time upon violation of any of the provisiona of t�td r Clarence Belisle NOTICE: 'IfiL pem�it does not eover the eonsTrueHon, insfallaHon for wiring, plumbing, 8as heating, asvyer or wa�er. Be wre to sae thd_,Buildfng Inspecto� fo� aeparata permits for lhese ifems, r AF.��CA�TQ� �� RE�IU��T��. �LT��AT��, �R A�A��TO� ��ILAT�� P�RNIIT �IT� QF F�T��Ye MINN�SQT� ow�,'s �: �1�� 1��2„tQvc� �trY�s �if�' C',�fs�%�'� > , . ., ^ 4 _.,.._._ �� z�ss: ��Z Zy �r��zc� � i�E ��ss; 37 �.3 , T-ex�-� ��'� .1'� � �_,..., , , , , , ,,,e �t�� ,� �� l �� s BI.oCK a , � �?T�zoY� � ,�'�. ��-� �� ` � t d� ��' �r� R P+� ■ � I e �.w+�sa�..w <�R L(3T: �� LOTi �y � S�TBACK� SIDEY�iRD: �i ,�,� �-��.: .�_n___„_---�.. .�+��,� �4:ad3 ��+��io Certificates of Sutvey o� Lqt at�d prop��ed �,�.��g �.+�cati�m d� s� #�se Certif�.catesa � � ��CFtIPTZp�i OF �UILDING ��iia�1�: � ..,; ��.+`�. � :' � *� � e-� � � � Dep�h: � $��ht: �l� .� �' ,:� � j� �'� �,�� --�� Sq�aze �'+��;�_ � � � Cabiae �e�3 � � � � � � ,._..,.,. �'rc�� t DeA1:h ; Hei.ght ; �qua�� '�et; Cubic ��ett �►{� °� �o�a�t.ruc�.+c�� Esti,�,aCed Cos�: $ � � �,� ',ti�' � , ----�-�-•-- �r� 3� t��a i� �'tt+c�er�0��d hesebg � a�l�c$tivn for, a pe�t €ar� th� w�xlc b�►rei.a� �P��,€'#�d� a�xee�ag tv da a�.l �ostc i.:t att�c� accordance witt� tire ��tyr �f Fs�dl�' t�t�d�s�ces a�ad ��.�a� �f �e+ Degart�teu� qf Bu��d#.x�e, t�i �ereby d�la�+et� i� a].1 �h� �tcts a�d ��reseu a�s a;ated ��hi� appl�catiau � �ru� a�d cvrrec� . � � � �� ,'�s,1 � � � � $I�NATp�E: � < � �� ►�re S#�t'� �og �ld�.�,o�a2 It�ort�atiaa.) - � `, , a° .: :` ,ar'' '='d f ` �;�_..ao _�� . �, � � 4 � � l,. ��`� _- � -` 'q ,'. ` _ - } ',"`�-_., "� ,� L �-�` � *:� w BUI�A�NG P�RMIT F�� H�AU�E STyCT�A� �. �e Inepecto� pf $u�ldi.nngs s�al�, beia�e ��sui�g permit� for the ��t�on ot a.ny building o� structure, ox for any additio� to any �is��g �� ox Stx4lG�urea o� fo� any alteration or xepairs to a,ny ex��ing ��a��Laig ox st�c�uxe, upon �ppli�ation theref�re, requ�re the p��a� by �h� ��i��tt �px su�� pex�nit o� �ees t:o the a�toun� herein below set fQr�h ��d �� m�as��x he�r��n gx�avided � t�*wi� s UI►�,FQR�i �UZLDTNG CODE z�pe I s 2� 4-$2 .15 �or ear.h a�rae zhous�d cubic �e�Ca ��' f�BG��.PTi the7cea�e in stt�b cubical coateAts. 3�pe 3& 5-$�..85 �ox �,� �na thousand �ttb3.c �ee�, � ��DiTIflI�1Ai� �NFL�tMA'T�ON FA� G13� �ux�ap�e of �aa�Pu�iLu� �ees for building permits, the cubical contents oi e�:y building or addition, is det�rmined by muitiply�n� �he �round area ��y��d, ��nq a poi�a� �#�c (�►� in�hes below the f loor line af the basement � i�e ��:�a�' �a tRe average �eights of the uppeT surface or to the averag� * �i,$�� I'ae �oc�� s�►r�ace o� �he main gable vf a pitched 7coo�, ��i� o�c a�lt+��at�o�$ �tt sa existin� $�z�t�'eg �3a� f�e shal], �e a� �he ��,�$ o� $�,flti #� �� q� h�dred dollar� �$30Q.00) � £�a�ei.on the�c�o� �.n �� ca�� a11 p�ca�aed wo��.�, 7� � cat�e s�a�� '�� ee fo�c a�r gex�it as se� ��tb �.a Se��ian 2 be � �an $�,�i. � V��I�ATiQN �� t9UNAATi+DN �'��: ��t3ts �� at�s��om w3.�1 be �.��ued a a��m Q� �4 i►raurs f�am �he � o! a�pplicat�o�,,� �Q a�.�oaa �ox Pra�er review of �he groposad a�au&tu�se a�td � �e �tstxttctioa &i�e. ' � C�'��i� �u�rv� o� �li� �.c��„ ��$ t� locat�a c�� Ith� �aundatirm, ��nc+� �� .� ��t�ct.�d�, wii�, �a �equir�d before proceedin� wf�h. � fr�f�. e C�R'�IF��'�£ QF IJ��PAN�Y �li.c�ti�a f�sx a G��cCi��.�afiRe a� Q�cugaucy �ha1� bs mad� �� +iiQ? a#�� px'�ox �o t,h� �$e �� c�up�g o�� y �c�ure �or which a build�.n� penai.� has b�;en i,ast�e�; �tc{ ��3.d s�et�xe� �ha2� �.ot D� used a� occup�ed u�ttil a��xtificate of tk;+�upamcy ha� bee� �.ssass�. � 's �_ � � _ _ � � __ _ SUBJECT PERMIT NO c�ty of Fridley �� 5 2 2 5 ' ` AT THE TOP OF THE TWINS g U I L D I N G P E R M I T CEIPT N. r ' ' COMMUNITY DEVELOPMENT DIV. � VV �� r j � PROTECTIVE INSPECTION SEC. a`� � � � ; � (_--• A �r��;,� CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BV L J\ 612-571-3450 910-F15 5/31/79 / / 108 ADDRESS 5224 Horizon Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION DESCR. �.3 1 Carlson's 5u�it Manor North SHEETTACHED 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Christine Opli 5224 Horizon Drive N.E. 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO. Lloyds Harne Improvement Inc. 1012 - 42� Avenue N.E. 788-5602 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR ❑ MOVE � REMOVE 8 DESCRIBE WORK Install vi.nyl si.ding 9 CHANGE QF USE FROM TO STI PU LATIONS SEPARATE PEFMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TMPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OH AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF COIJSTRUCTION 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 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 GRANTING OF A PERMIT $3�S%O y�]..93 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHqRGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $24.00 PLAN CHECK FEE TOTAL FEE 1'� � - � � � �- � � $2 5. 93 SIGNATUfiE FCONTRACTORORAUTMOR -AGENT �DATE� � WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT ` r-.: � � � � SIGNATURE OF OWNERIIF OWNER BUILDERi IDATEI BLDG iNSP �q7 , . ,- . CITY or- r-�zz»�_cY . /�PPLICl�TTU11 !'Oft I2LSIllt_t��TI�L BUILD1h1G f'CftI�iITS , ', (f'�L'W, •�L.1'LRl1T1U(dS, �I?UITIO(d�, OR RL"('AI(2S) • . . . . ��.. . OW[2�I2: � ~ ,��, I3UiLllI.12: r�aar�s� : p �� naar�::� : ,1.�,�— �2-�� '� �% � � . �� •Te]. . IQo . : %�� / � ' No. : � �a ��_ � Street: r.oT: /� �rACr,: CO121�ER LOx: II�SID� TAT: S;:TLACY.: STD�YnRD5: ' Applicant attach to this ionrt ZZ�10 Certificatcs of Survey of Lot ar�d pxoposed bui.�.ding locatian drav�n on these Certiticates. . � To Be Used 1�s: DESCRIPTIOId OF $UILDI(�G Front: Depth: � � � Heigh�: Square Feet: Cubic�Feet: � i'ront: Depth: ' � Height: Squai:e I'eet: Glxbic Feet: ' Type oi Construction a � Estimated Cost: $� �•�a ,.,�� ;' i xb I3e Completed: � / �j � � � ' Alt. A Alt. B Proposed Driveway Wid- Ii Y�ew Opening xs Desired $ � $ ' (Si� It�V�RSE SIDE OF Si�EET) The undersigned hereby makes application for a permit for the work herein specified, agrecing to do a11 t.ork in strict accazdance wit1� tl�e City of . Fxxdlcy Ordinances and ruli.ngs of the Denartment oi Euildings, and liereby deelares Lhat all tlie facts and regraseni:ati�ns stated i�i t}iis application axe true and co�:rect. �S�e reverse side t�r acldiL-ionnl ini'ozmation. DT�T�: SIGNATUJtE: Stipulations: , � � �� . 19.� �� _ 93 • �1 `� , - BUILDI(JG PERt�IIT FEt SCNEDULE SECTION 2. The Inspector of }3uildings shall, Uefore issuing peYmits for the erection of any building or st-ruCture� or for any addition to any existing building or structure, ox for.any a].tex'ation or repairs to any existing building or structure, upon application therefore, require the paymenti by the applicant for such permit of fees to Lhe amount herein below set forth and.in the manner herein provided to-wit: . NEW CONSTRUCTION: Single Family Homes and Garages: $4.00/1,000 cubic feet. PLAN CHECK: 25 percent of building permit fee. . DRIVEWAY D�PF2ESSION: (Concrete C� rb Streets Only) • Alternate A: Removal. and replacement of concrete curb and gutter only; Driveway width plus 6 feet x$�,5,75 � Alternate B: Removal and replacement of concrete curb and , � gutter and install a 3 foot wide approach with • 6 inch depth; Driveway width�plus 6 feet x$17.85 ; 1 1 �:. 1�' ' � 1 For the purpose of computing fees for building permits, the cubical contents of any building or addition, is determined by multiplying the ground area covered from a point six (6) inches below the floor line of the basement or th� cellar to the average heights of the upper surface or to the average height of �:he roof surface of the main gable of a pitched roof. For repairs or alterations to an existing.structure, the fee shall be at the rate of $3.00 ner each five hundred dollars-($500.00) or fraction thereof in tlze cost of all proposed work. , In�no case shall the fee charged for any penmit as set forth in Section 2 be less than $7.50 plus $.50 sta.te surcharge. • • � � � 1 1�: �l NOTE: Permits £or cons:truction 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 been construc�ed will be required before proceeding with the framing. : : � � ':1 Application for a Certificate of Occupancy shall be made ten (10) days prior to the use or occupancy of any structure for which a building peYmit has been issued; and said structure shall not be used or occupied until a Certificate of Occupancy has been issued. ��._ � �, sue�ecr PERMIT NO. City of Fridley `�`�- ATTHETOPOFTHETWINS g�iLDING PERMIT 2245 r � . , � / �� 1 y�___� COMMUNITY DEVELOPMENT DIV. r i � PROTECTIVE INSPECTION SEC. I = � � �'�'1 � CITY HALL FRIDLEY 55432 NUAABER i1EV. DATE PAGE OF APPROYED BY �"""� � ,�� 612-571-3450 910-F15 4/26/94 � � J08 ADDRESS 5224 Horizon Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. ],3 1 Carlson's Summit Manor North SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE John Trentor 5224 iiorizon Drive NE 3 CON7RACTOR MAIL ADDRESS Z�P PHONE LICENSE NO. Durabilt 7343 Ann Court, Eden Prairie MN 55346 938-9350 3004 4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK � NEW ❑ ADDITION O ALTERATION O REPAIR ❑ MOVE f�l REMOVE 8 DESCRIBE WOFK Remove existing 14' x 23' Garage and Construct a 22' x 20� Attached Garage 9 CHANGEOFUSEFROM TO STIPULATIONS Provide a hard surface driveway. See notations on plan SEPARATE PERMITS ARE REQUIHED FOR ELECTHICAL, PLUMBING, HEATIN(i, �PE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THiS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED Oli ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APPLICATION 1 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 GRANTING OF A PERMIT �lO�OOO �S.00 DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $117.00 Fire SC IO.00 STRUCTI N OR TH PERFORMANCE OF CONSTRUCTION � PLAN CHECK FEE TOTAL FEE License SC $5.00 $137.00 SIGNATIJREOFCONT CT RORAUTHORIZEDAGENT I�ATEI WHEN Fi V VA ATED TH�OUR PERMIT _ �_ f 1� G� +J � /T� � SiGNATUREOfOWNERiiFOWNERBUILDEIi� IDATEI BIDG �NSP �1ATE IvEW ADDN ALTER �� l �� CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Effective 1 / 1 /94 Construction Adciress: S aa 4 y op �-Zo,,� �� i V l. Legal Description: �..0'� � 3, 1� �Oc.�l( �,. .%.wi`So.� S��a�•�:} �4►t�o r, No r'N� � o!dI� �16 � Owner Name & Address: �pl�h �V��"�Q�' Tel. #S1 � a634 Contractor: � � ry,b ��'�" MN LICENSE #� 0 p 4 Address: ��4� ��. Co.,i'f" Ea��. Q�a'cr��- , SS'��i'�6 Tel. #��g��5 6 Attach to this application, a Certificate vf Survey of the lot, with the proposed constiuction drawn on it to scale. � LIVING AREA: Length GARAGE AREA: DECK AREA: DESCRIPTION OF IMPROVEMENT Width Height I.ength a a. Width a�_ Height � D• �- — Length Width Hgt/Ground Sq. Ft. Sq. Ft. 44.__� p_-__ Sq. Ft. OTHER: vrt., {, 2 � (ywrw k- ��LL2aC�n. �D x � - � D�o• �� fih��a _ ��7C�� m ��.�1� Comer Lot [] Inside I.ot � Ft Yd Setback Side Yard Setbacks ,� �� Type of Consiruction: `11�b Bt� Estimated Cost: $� p, Ooa°� � Approx. Completion Date: � ,+ (Cost on .8ack) Driveway Curb Cut Width Ne,�ded: Ft. + Ft = Ft x$ _$ DATE: � APPLICANT: Tel. #� 3 g"'� �� T� Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Patk Fee Sewer Main Charge TOTAL STIPULATIONS: �D y�, � � R �� $ ��a��-1 $ '� , , --� $ $ �� $ $ $ $ $ `.J � �� CITY USE UNLY Fee Schedule on Reverse Side .(�1 of Permit Valuation (1/lOth%) $.50/$1,000 Valuation $800 per SAC Unit $5.00 (State Liceased Residential Contractors) Alt. "A" or Alt. "B" Above $450.(� Conservation Plan Review Fee Determined by Engin�ri.ng Agreement Necessary [ ] Not Necessary [ ] w BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before iss�ting perniits for the erection of any building or structure, or for any addition to any existing building or shucture, or for any alteration or repair to any existing building or structure, upon application therefore, require die payment by the applicant for such permit of fees to the amount herein below se� focth and in the manner herein provicied to-wit: , � ' ;TOTAL VALUE ' . , pE.� $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 $15 (Minimum Fee is $15 plus surcharge) $15 for first $�0 plus $2 for each additional $100 or fraction thereof, �to and including $2,000 � .$45 for first $Z,000 plus $9 for e�ach additional $1;000 . or fraction thereof, to and including $25,Q00 ' $252 for first $25,000 ples $6.50 far each additional $1,000 — or fraction th�eof, to. and iucluding $50,000 $500,001 to $1,000,000 $1,QOU,001 �nd up $414.50 for first $50,000 pius �$4..50 , for each additional $1,000 � or �'raction � thereof, to aad including $100,000 $639.50 for first �$100,OQ0 plus $3.50 for �ach addifional � $1,�0 or fra.dion th�eof, to and including �$500,000 $2039.50 for the first $500,000 plas $3 for each addition,al $1,Q00 or fiaction thereof, to and including $1,OQ0,000 $3539.50 for -'the first $1,000�000 plus $2 for each additional $1,000 or fraction �tHereof • ' DRIVEWAY DEPRESSION ESCRORr (Coacrete Curb Streets Only) Altemafe "A": Removal and r�lacement of curb and gut�;er only - Driveway width plus b feet tim� $13.50. Alternate "B": Removal and replacement of curb and gutter and iastall a 3 foot wide. approach with 6 inch depth - Driveway width pius 6 feet times $15.75. VERIFICATION OF FOUNDATION Permits for construction will bs is.sued 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 S�uvey of the lot, showing the loca6on of the fvundation once it has it has been constructed will be required before pro�eeding with the framing. o . -- � .. a ►- ad+.�� } �� , S � � � �` Y�� Y�� _�d r '-" ��d a u � r a a p��ooA 0 . 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P vi . ... u rr �000.- �m o�� -�� :� _ � aa �o�n"'� �+os � �^�'+ � x=m m ; aa �� '' Zz �� n r r y O 1 'O'O fJlwi 30 .. 00 �+ 041 p 2 2 Z --�� ,�, 70."O . N� 9a . . ti1i0 .�.....m 2Z1'Y v ^ -�ao — ��^ � ' "� 1� � S mm� (C fD tD � � � � fp +^ � Gh -r V� A Q' u n � � C ,�„`G �� „� 'p � ♦ �� N � � � NN V„�� '^, �• tn = �� a�� J A I'.� � � 3 41 L' � �rn�� Pa C �' " �- � y � �OC QS � N d = � �_�. � L � r. `� � � � ' _ �.� 3 � O ;� � m O � V � � �"* � � n- ^` �� H� N � (ap n C77 -� � (� � �+ :_ti ... � °�-°,• 3 °` N � `G � SuBJECT pE �__ City of Fridley ,� 4 � �� . � AT THE TOP OF THE TWINS g � I L D I N G P E R M I T � r � . � � RECEIPT NO. � • COMMUNITY DEVELOPMENT DIV. , �� ------. ��r r � � PROTECTIVE INSPECTION SEC. � � i � /"'1 � CITY HALL FqIDLE� 55A32 NUMBER REV DATE PAGE OF qVPROVED BY �'""'� � �'' 612-571-3450 910-F15 9/4/96 / / JOB ADDRESS 5224 Horizon Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 1 Carlson's Summit Manor North Addn SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John/Connie Trentor 5224 Horizon Drive NE 574-9634 3 CON7RACTOR MAIL ADDRESS Z�P PHONE LICENSE NO Same 4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE UCENSENO 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW a ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE x 8 DESCRIBE WORK Construct an 18' x 12' & 4' x 4' Deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan �' I�I � � B � �' � ��6 ; efore �rgo�1�� aq fp� ; SEPARATE PERMITS REQUIRED FOR a11 �r'I'rY +��t��s 4,�'•0002 � WIRING,. HEATING, PI.UMBING AND SIGNS. ��QU'�� BY (,A}� SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. 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 CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STAILS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yqLUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL 8E COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �2sO93 �1.OS DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL 7HE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- @ STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. y�74. %S Fire SC �Z.O9 PLAN CHECK FEE TOTAL FEE $77.89 �GNA REOF ON AaCTO Oa u Oai T �DATEi WHEN PqOPE VoALI ATED THIS IS Y UR PERMIT �6 ��'� S�GNATUREOFOWNERiiFOWN RBU�LDEF7i IDATEI Q- BL �NSP qaiE NEW � ADDN [ ] ALTER [] CITY OF FRIDLEY SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress: ��.� ;� � �, � Legal Description: � Q �' s �, �p�� j��L �, � Effective 3/1/96 �`� � ^ V . � = - ��i/� Owner Name & Address: �� l0� ��n,)c,,, I z c � ��p� Tel. # Contractor: �%��L � MN LICENSE �# Address: � �141'1'1 �` Tel. # �� — t� � �'� Attach to this application, a Certifica.te of Survey of the lot, with the proposed consiruction drawn on it to scale. DESCRIPTION OF IlVIPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECS AREA: Length Width �� Hgt/Ground � Sq. Ft. �� OTHER: �i y' � �3�Y�s�� Comer Lot [] Inside Lot [] Ft. Yd Setback Side Yard Setbacks a� 3, 3� Type of construction: �� J� Estimated cost: $ c�9 ,�Z Approx. Completion Date: � � � 7 --` fCost on Back) • Driveway b G�t Width Needed: Ft. + 6 Ft = Ft x$ —$ DATE: g /`� 6 APPLICANT: Tel. # S7G/- --�'i63 Permit Fee Fire Surcharge Sta.te Surcha.rge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ ,� � ?. Q� $ ,��.� $ $ $ $ $ $ � � �'i CITY USE ONLY Fee Schedule on Reverse Side .�1 of Permit Valuation (1/lOth%) $.50/$1,0� Valuation $900 per SAC Unit $5. � (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 PERNIIT 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 $100,001 to $500,000 411. �', 1 Z�',•:'y r' j 7y �� $500,001 to $1,000,000 $1,000,001 and up FEE5 $21 (Minimum Fee is $21 plus surcharge) $21 for first $500 plus $2.75 for each additional $100 or fracdon 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,OU0 $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,�0 plus $6.25 for each additional $1,0� or fraction thereof, to and including $100,000 $887.25 for first $1�,000 plus $5.00 for each additional $1,D00 or fraction thereof, to and including $500,000 $2887.25 for the first $5�,0� plus $4.25 for each addirional $1,0� 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 fracrion thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Alterna.te "A°: Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50. Alterna.te "B" : Remaval 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 cons�ucted will be required before groceeding with the framing. f (� /� _w �. �-� �� . � s--.''�. ��` .� Z � Z-- � • ` � �� a. , � _ �, � — �� f � � � ! � � � � � �v `" -c ° �! � D �j/� � —� x - � ^ : ^ c- R' . r_. 3 o � � .� � i �:�-+ � i Q � Y y � M �I � � } � s' �`+ -i -.a� 0 s : � n � x � o � `� -1 ♦ -e "' i � � ti A t � i �g" , O � .�. ~ � � L � z ^ •z o � . a � n � � N O O ^ �Q.., � �N-i � m ` _ .� _ n R } -•� � � W 2 r� n�rC �N�7 O -�t = f�*t U � � � y�, 2 C' � � � � � � � � � � .� w = ,� � � z r, �^ N � � � z o ,�x� n � �'O( A . U � U � � N � ' � ��p,' � p,� Pd�r � 0 � � � � ^{ rPgp � Q T r€ v � � • � � j� r _ �� 1 � �. � � � f' �` -� U" j �'' D C ; � ,�--- �. o�� - r �� eza h�. . - --- �-�- -_ -- --- � � � ,.--- . _.._ � �- . -�-- - ._. . --- .. . � ; � 7� � �, �'�Z::�. -Z o � _ � 1� � � �� _. _:_ _,�::- � 4 �spWeo v� o r��__ � � t p . -. '1 ! D � � C t�R�°= � L��= ;' � o ; G'r=; � � �, �. • o� �: � � " � -� ��,:rt - .� ��'�_ : � �7 6 aX�i .L /� % a si2 r� 4' Top View of Your Deck The Scale is 1/4" : 1' 18' � -.� C�'C 80<�-1 l� sN�N�S N��c2-r .2 X ; G �K.�F7c' , aX� a1X-z Q �r �1 � aXi� �� v� C��a� r� �G�c��..N�� ) IE, �,�,.; y ��z�_ (3�TC�� E�A�Z � �Tw��i�s, Li--��(�,u�s �C�.a2 � a_ aX��, ,� v s �-Ts l� ��; �'F,,,-r�( Your deck is 8' high The deck is designed for a 60 PSF live load. , �� Clty of Fridley sue�ccT PERMIT NO. AT THE TOP OF TME TWINS g U I L D I N G P E R M I T 310 6 5 � S � RECEIPT NO. � `� _��_� COMMUNITY DEVELOPMENT OIV. �� j � � PROTECTIVE INSPECTION SEC. � � _ , � �"'1 � CITY NALL FRIOLE� SS�32 NUMBEp AEV OATE vAGE Oc AvPROVED B� �'""� � �'' 612-571-3a50 9�aF�5 6/15/00 / / J08 ADDRESS 5224 HORIZON DRIVE NE t LEGAL �OT NO. BLOCK TiiACT Oq ADDITION SEE ATTACMED oesca. 13 1 Carlson's Summit Manor North SMEET 2 PROPERTY OWNER MAIL AOORES$ 21P PMONE Trentor 5224 Horizon Drive NE 612-574-9634 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Budget Exteriors 8017 Nicollet Ave. M ls., MN 55420 612-887-6131 � ARCMITECT OR DESIGNER MAIL ADORESS 21P PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS 21P PHONE LICENSE NO 8 USE OF BUILOING Residential 7 CLASS OF WOFiK O NEW O ADDITION � ALTERATION � REPAIR O MOVE O REMOVE B DESCF118E WORK Reroof, Reside, and replace windows Permit Ins ectio Will Be Malled 9 CHAN(3E OF USE FROM Tp Aff1�/��nn� O w rii11 if ��ii (� STIPULATIONS Reroofing Stipulations - Underlayment must comply with the State Building Code. Residing Stipulations - Per Section 1402, 1997 Uniform Building Code, requires that a weather � resistive barr'ier be placed over exterior sheathing to protect the interior wall covering. Exceptions for this provisio� would be if sheathing is an approved weatherproof panel or when the siding is an approved weather barrier. Vinyl siding is not a weatherproof covering unless the manufacturer states this in their application guidelines. Call for inspection of wrap before covering. Window Replacement - Provide smoke detectors in all sleeping rooms and"on all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. SEPARATE PERMI7S ARE REOUIRED FOR ELECTRICAL, PLUMBING. NEATING, TYPE OF CONST. OCCUPANC� GROUP OCCUPANCV �OAD VENTILATING OF AIF CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK Oii CONSTRUCTION 20NING SQ. FT AUTMOqIZED IS NOT COMMENCED WITHIN � DAYS. OR IF CONSTRUCTION CU. FT. OR WORK IS SUSPENDED OR ABANDONED fOR A PERIOD OF 120 DAVS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I MEiiEBV CEiiTIfV TMAT I HAVE READ AND EXAMINEO TMIS APP�ICATION 1 STA��$ GARAGES ANO KNOW THE SAME TO 8E TFUE ANO CORRECT. A�L PROVISIONS OF LAWS yp�UATION SUR7AX AND OROINANCES GOVERNING TNIS TVPE Of WORK WILL BE COMPLIEO WITH WHE7HEq SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 14 435.00 ],21 DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE Oq CANCEL THE pERMIT fEE SAC CMARGE PROVISIONS OF ANY OTNEfi STATE OR LOCAL LAW REGULA7ING CON- STRUCTION OR 7HE PERFOfiMANCE OF CONSTRUCTION 289 .�►,rj Fire aSC 14 35 PLAN CNECK fEE TOTAL FEE License SC $5.00 $316.01 S�GN4fUpEOFCON'NACTOpOA4UTHOA�ZEOAGENT �D�iE� yyM PROPEiiIY VALIDATED THIS IS VOUR PEAMIT — �o /li BO S�Gan iUAE O� OwNEa �� OwaEa Bw�DEp� �D�tE� �NS� �i� rE �`! .� [ «] A�01�" " . [ ] CITY OF FRIDLEY ALTER � ]� SINGLE FAMIL�( AND DUPLEXES R-1 AND R-2 � BUILDING PERMIT APPLICATION �� !� �,� ' Construction Address: �i �� '> �zo�-, ,�� Legal Description: Owner Name & Address: Contractor: f �� Effecfive 1/1/2000 612-572-3604 Bldg,nsp S�i� ,��.� - (� �� /1a��/ �� Tel. #�'/ � _ .S'7 �/6� e MN LICENSE # Address: �la/ '� ��-v�l� �� l�J� ��' � Tel. # f�'2--�� /�j � �' � ��. LMNG AREA: GARAGE AREA: DECK AREA: OTHER: �I Attach to this application, a Cert�cate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft Length Width Leaath Width Height HgUGround Sq. Ft Sq. Ft � + � � �S c,�, � n� � S� � v � f��r d� ? � �o �) � Construction Typ�7�va � ��" � " "" $� Estimated Cost: $ �/�� '�U ( � C�S '� �� Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$ DATE: �� /S� � APPLICANT: Tel. # �1°�7�� CITY USE ONLY - Call (612) 572-3604 for Permlt Fees if mailing in application Permit Fee $�� ySFee Schedule on Reverse Side Fire Surcharge $ /�f � 3�� .001 of Permit Valuation (1/10th%) State Surcharge $ %, -� 1 $.50/$1,000 Valuation SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee $. $1100 per SAC Unit $ ��s � $5.00 (State Licensed Residential Contractors) $ Alt: "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [] Not Necessary [] TOTAL $ a � ( STIPULATIONS: S�Q(JQ(1 � �� 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,Ot� 2,001 to � $25,001 to $SO,Q00 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,001 and up FEES $23.50 $23.50 for first $500 plus $3 .OS 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 fraction �her�of, to and i�cluding $25,Q� $391.25 for first $25,000 plus $10.10 for each additional$1,000 or fracdon 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 $100,0(}0 $993.75 for first $100,OD0 plus $5.60 for each additional $1,(�0 or fraction thereof, to and including $504,000 $3,233.75 for the first $500,000 plus $4.75 for each additional $1,000 or fraction thereof, to and including $1,000,000 $5,608.75 for the first $1,000,0(10 plus $3.15 for each additional $1,000 or fra.ction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets �ly) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50. Alterna.te "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. 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 S�rvey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. New Houses Onlv . � m � C n O � � � � m m � �o O c� � � Z � � z � O 0 z 00 D n � � v m .��m � � O� o,2c�i � m? � c � -n o Z� �v� �OV c � o � � o m� � 'f'� 1 D� v � �� 01 D � Z �v � -� m � z � � � � z � v a � � .� � � � 0 c � � � v � m -n m � r ?� z v ° w ,� l r � J cn � c) o0 0o O z 0o G� G� �� c m o� o� o- � � w c� ��- v, v, m m rn�� v .n v � -, � � v � �' p v -v -r! � �Z � 2 2 -i � d W � vi � � � � �O w � N � N N, W � �• -Ci � ,� � � � v � � 7 N 7 �p N -+ + -, -, � �� r . N m G� m D�° � � m� a � � m -o -� m � c��n �; � �°, � � '� � ' � � '� '�. � m m m a v � � z 0 I I I I I I I I I�I I I EA di iA tfl EA �(f► EA <iN 4A {fl �!! (!1 �71 O O O v O v V�I V U� A�I °o o° °o °o o °o °o °o °o °o °o °o °o i y W O = a W d �' � Z a C � � N O � O � � _ is � m � � _� -� � � �1 � ►_ �— C � t— � � v r C � W Z T -�i C � m � m � z O � m O D r � W D v v � rn � � � � � °o 0 0 °o -, -, -, � 1�. W N � C �' d :::::<t::::.,... � ............ � � S �D C -, � � �:`;;...<� � t.::.:;�:: �::;�:;:>:::: :!�`:.>::;:::::' O .:......;::':: � � d N � ��'' ''' ' � �i::;:i:. �:';�;`: m � ;v:::��: D �. o � m v .�, o �?:::�.;; z �`::::� : ��" 2 ��::C. r ��O � � G� m � x � m� m � � THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR 1`HE �lPPLICATION WILL BE RETURNED r-nM�unn� v��T v�ti-r �n�NFr_TnR nNn cnnngi �s-nnN AiR vFUiFicA�noN �e� ;� �� acinp a�p �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 plastiGPVC 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 manufacturer's specifications. This does inc�ude AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. Yes () No () Thg BYy� �e e��en air is sized and installed to meet the current codes and manufacturers specifications. Yes () No () When required to �n�t�� ' n_�v _omb ��tien a�ri it will be sized and installed to meet the current codes and manufacturers specifications. Yes () No () �e� :.+�t�llina a np�•� ventin0,,, y� m, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturers speaflcations. 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 (). T and Si�elGnmmen �/ent and Vent C'nnnec+er Informatinn �� Appliance #1 Type � BTU Input Fan Assisted or Nat AppGance #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 Appliancs #3 Vent Connector Height ft Length ft Diameter in Type r_ :., .- - - HEATING C0: Signed By: Date : � _ CITYOF FR[DLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287 Apri127, 2004 Mr. Hans Iverson/ Ms. Sadie Evens 5224 Horizon Drive NE Fridley, MN 55421 Re: Final Inspection at 5224 Horizon Drive NE Contractor: Homeowner Dear Mr. Iverson & Ms. Evens: A plumbing pemut was issued on December 17, 2003 to install a water heater at your address. An inspection on 7anuary 15, 2004 noted the following conections that needed to be completed before we can final the permit; 1) Provide combustion air per Section 604 of the State Plumbing Code. 2) Provide an approved gas valve (AGA valve). 3) Atta.ch the vent pipe to the vent connector. 4) Overflow pipe must be within 18 inches of floor. 5) Maintain one foot to combustibles. The conections must be completed and a reinspection called for. The permit fee that was paid covers the inspection to make sure the work was completed according to the Code. To set up the inspection or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. " Sincerely, .-__ .-__- _-- I 15�0�6 `O�ITY OF FRIDLEY MINI �- (Z�3) 572-3604 ADDRESS � OWNER � �� BUILDER _\\ INSPECTION REPORT DATE If no corrections are listed above, approval is hereby given to proceeds. You will be in violation of the ordinance if you do not call for the proper inspections and make corrections as called for. Building '�nspections 763-572-3604 763-502-4977 FAX DATE � d r! srre .4nnxESS � 1'HIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERMIT TYPE TYPE OF WORK: MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 2-19-09 YOUR E-MAIL ADDRESS -b riZc�� r • 1� ❑ OWNER �CONTRACTOR N� PHONE: � I 2 ,.J -' �-�'i g� Z COMPANY NAME: ' CONTACT PERSON: a� • � � Permit No. Received Date STATE LICENSE # � EXP DATE ADDRESpS:`756� IJU�C�1�`�l �.� S CTI'Y_Ecs��t�0` STATE�vZIR��3-/ PHONE lSZ • s?jS � FAX �SINGLE FAMILY ❑ TWO FAMILY ❑ NEW �REPLACEMENT DETAILED DESCRIPTION OF WORK 0 TOWNHOUSE ❑ ALTERATION/REMODEL FEES ARE BASED ON $10.00 PER FIXTURE, XCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOV►� Equipment Installed MFG: MODEL;,�S�i V b�/Zb � SIZFJBTU Q p MFG: MODEL: �ZYI�N'�iOZ y SIZFJBTU �� , A/C $25.00 AIR TO AIR EXCHANGEER $15 _BOILER $35.00 CHIMNEY LINER $10.00 DUCT WORK $10.00 Number of fi�ctures a�i $1p.U(? Number of fixtures @ $1S.Oi� _ Numher of fiact�ures a� $2S.(}� Number of fixtures �',a? $35.Oq �' State Surcharge = $ .50 ' MFG: MODEL: FIREPLACE (GAS) $15.00 FIREPLACE (WOOD) $35.Q0 1 FURNACE $35.00 GAS DRYER $10.00 GAS PIPING $10.00 �It1.Qfl ��- $ � �� $1S.UiI = $ �2S.a� �_ � �'> D o $35.DU - $ J�• Q{� b b:: S' � SIZEBT[J GAS RANGF/OVEN $10.00 IVEW GAS GRILL $10.Q0 GAS UNIT HTR $10.00 _POOL HEATER $35.00 VENTII,ATOR $15.00 THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTII. PROCESSED I hereby apply for a building permit and I acknowledge that the informarion 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 of all work which requires review and approval of plans. SIGNATURE OF APPLICANT(�/�jA�j (�/� PRINT NAME V v Olp11C_S E'.Dl A W� (..� DATE E� I d D � City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 �