AF - 46338� n
City of Fridley, Minn.
BUILDING PERMIT N° 4 3 0 5
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Date: -------.1.._._._.----.._...__._�..:.�._..,._.� _.�...__._...._.
Owner: •--.------.-----. Builder �mf�-..QF!��{ �-�'%'��%��� __ � _
Address
Address
� LOCATI N OF BUILDING
No. �'�f.._I.�... Street . s�����-- •--- -----�..��-.�.........._..---------- Part of Lot
Lot ....... ............................. Block ....._.....---........�......... Addition ar Sub-Division ....._......_..............
CornerLot ..........................- -...... Inside Lot ....._................................ Setback --� -..............._..-�-----..._........ Sideyard
SewerIIevation _...---......---�--�� ...................._...._..--�----...._.......------��----........._...--�-- Foundation IIevation _...----.........
DESCRIPTION OF �UILDING
To be Used as:
//� �i t� o ° f � �%
�O-`�� -��. .....--- --. .... �nt �e..-_� �p� ..�.....9...-.� Height ��...:...� Scl. F����.. Cu. k't. �-- -f�--..�°
...................._....._y�� � ........... Front ...................._.. Depth . ..........--- .. Height .............. - . .... Sq. F't. ...................._.. Cu. F� ..----.................
/ �fp �
Type of Construction .....��°!":!-�--.—.—.......... Est. Cos ..._�!. ..J ./ .��...__...... To be Completed ....._..--.---••--•---...-•------_--..._........
In considera.tion of the issuance to me of a permit to construct the building described above, I agree to do
the proposed womk in accorda.nce with the description above set rth and in complian wlth all provisions of
ordinances of the city of F'ridley. r���
:. _ � . •-- ..._. _._.._._.___.__._.. �:�. �..__._.._..
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In consideration of the payment of a f� 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 peison 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 res�cts to the ordinances of
Fridley, Nlinnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. � �
Building Ins�ctor
PIOTICE:
This permit does not cover the eonstruction, installatien fo� wiring, plumbing, gas heatine, sewer o� water. Be sure to see
the Building Inspeefor for separafe permits for fhese items. , �
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City of Fridley�, Minn.
6431 Univeraity Ave. N. E., Muineapolis, Minn. 55432
BUILDING PERMIT
��; November 3Q. 1972
��� Edward J. Fitzpatrick B�d� Bauer The Builder
� 5273 Horizon Drive N.E. Address
��
��1181� �
LOCATION OF BUILDING
Na 52�3 s.�t Horizon Drive N.E. _ P� ap �ti
Lot , � 83�k $ Addition or Sub-Division Carlsoa's Summit Manor North
Corner Lot Inside Lot Setback —. Sideyard
$ewer IIevatian Fonndation IIevation
DESCRIPTION OF BUILDING
To 1� Used as:
Finish Basement �nt Depth Height � Sq. F't. _._.. Cu. Ft
Front Depth Height Sq. F't Cu. Ft.
� oP ��� ���$3, 700 To be Completed 2 months
In cons4derai3on oP the issuanoe to me of a permii io c
�he pra�sed work in acc;ordance with the desc�iption above
�Tdinances of the dty of Fridleq. ���
building des bed above, I agree to do
� in com an�e with all provisions oE
�
1.85 Stat� Surcharg�,�/
In con$ideration of the paymettt of a fee of $ B� 24. 00 ' E.dward J Fitz atrick
, permit is hereby granted to • P
to construct the buildfng or addition as desc�3bed above. This germit is gra.nted upoa
the express condition that the person to whom it is granted and his agents, employees and worl�nen, in all work
$one 3n, around and upon said building, ;or any part thereof, shall conform in all respects •to the ordinances of
1�'rldley, Minnesota regarding lacation, construction, altera.tion, main.tenance, repair and moving of buildiIIg�
�� dty ]imits and this permit may be revoked at any time upon viola.tion of any of the provisions of said
Bwuding Inspector
DARREL CLARK
NOTICE:
ifiis permPi doea not cove� the eonatruetion, installaHon for wiring, plumbing, eaa heatfng, aewar or water. Be wre fo sas
t6s Buildfng leapector fo� separate permHs for these iteeu.
AF.������T�� ��� �E�I����i��. �LT��AT���,
0� ��A�TTON ��zL�TNG ��RMTT
�IT� QF F�in���e MINN��QT�
QW�T�' S NA�4� : G d`^� J•/' i�2 A�,t ��/C BiTTL�1ER :�'� a cc E v �'%s Q u i/�� r
.,. —�------a--
�iDIAD.tE3s • S 273 �d r,�,o r, , �„�. A�?�.5� s
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; �� �: � � • �� �:��_� � �� � yi`vv �.�.�..
� LQT; �� LO�i SETBAGRg SIDEY�i,RD:�,,,,,
.��3.� ag#.s�d� �v, ��+�t_ ia Certificates of Suxvex of Lp� a�d proP���d
�,�.�� �aacati,� d� s+� #�es�e Certificates, .—
��aCFtIPTIfJN OF BUILDING
� � i�e� ,!►a :
�,,�,�%l ,� ,��,�✓1 � D�ti�: �i�iet:
S��a�e �'��3 Cub% �e�3
�'rra�t� s Depth : Height :
�jua�s �'get ; � c Feet t
«�✓/
�T"' D3, 4/o�i�6.iM�.7►��� ` Estiasqe�ted Cost i�' �wf e�� �
/�J / `o
R�M � M��`�4�Y�'� �� / w.�l! i !/^+��
� sr��#��d hereby �e+� a�rpl�caCion for, $ pe�ai.t fa�� the w��k be�rein
�p��,��..ed� agxee;La� t�+ da a�� �Tt�7ric ist stt�.ct acco�daace wittt the G�.�► of
$'!G'.l,di��' �l�d�e�e �d i'tt�,�� s�� ;.he Depart�aen� Af Bu��di��, � laes'ebp
dl�las� 1� all �h� �acts a�d s��eser�ta�i.ons sLated i� t.�ie a�I�,caticm
�a � a�d aprre.�fi� .
�,1'ias� ' Z � SI�1�IATO�E • '
�� �t;'e� S�d�► �o�r Add#,�oaal In�os�qation.)
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�S ��
BUT��ING P��MIT F�� ��H�DU�E
SF��QN �. �'he I�epec�a� pf �u�ldings s�al�, befaxe �asui�g permit� fo� �he
����fi�on o� any bu�lding ox s�zucture, ox for any addition to any �ist��g
'��.�iAd�,� oz struF�ure, ox fo� any alteration or repairs to any exi.��ing
�ia�f,l�l�.� ox stx'uc�uxe, upon �pp13.�ation theref�xe, require the paym�m� by ��ts
�.�;���.1��� fp� such p�ru►�,t of� �ees Lro the a$toc�nt hesein below aeC fAr�h ��gd #.n
���; �s�� hsx�ei� P�QVided �o��wit t
UI�TdFpRM &U�LI3TNG CODEt �pe �� 2��i -$2.p5 �ar each ame zhous�d cubic
�e�fi, �� f�ac�ian th;e�e�a£, in auc� aubical cont�nts. �rpe 3&� �$�.w8S �oae
�a+G�t �r�Q �housand �b3.c �ese�„ .
A�DiT�fl�1AL I�iF(�tMAT'�ON
FQ� �� pux�ose of �u,mput�.t�g �ees for building pextoits, the cubical contents
og �y buildin� or addition, is det�xcnined by mui��.ply�n$ �he g�ound area
����. �c�m a poia� ��x (6j inc,�ies below �he flc�or line o� the basement
+� t�e ���.la� �o tt�e average he�tghts of the uppes surface or to the avera��X
��'a1� �� � �'o�� �c�'face o� �he u�a.it► �ab�� Q�f a pi�ched xoof .
�►�' �i�rs o� a,ig��ca�t�.ot�� � aa� existin� s�ru+��ce� �a� fee shal�. be �� �h�
�'��� o� $�*� �e�' ��,+c}� f�ve h�dsed dollars (^��OQoU43) �c f���ion th�x�of ��
�a;� c+�s� a� all. p,�cap�s�ed wo�kc�
b� �c► c�€ae sha3�l ��s �� � fo� �yr ge�it as set ��� �.a Se���ot� 2 be
�.� ��A $�.�,
�
V������TiON OF �t3�1NAATI�N
�i'�� ��u�ts �+�� �oAS�����oa will, be i,$$ued a ��a,i� o� �4 �c�urs ��am �hs
�le u� �,g,piicat#,a�, �o A��c�av �o� prage� r+eview oi the p�ropos+ad a��u&tuxe �d
�� �e �st�u�tion &i�e.
' ��C���i� S�� v� t�Ii� la� ��g ��oca�� cai Ith� �Eauudatir�, omce �k
�a� ��r► ��s#�t.��l�, wii� � g�,uix�d be€o�e t�r � w��h � fr�3�.
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C�R�'�F��Ai� Q� (���PAN�Y
��F�i�tt��� fra� � I���#.�i�afi�. o� Occu�aucy ahal�. bs madea �ea (1Q) d���s p��or
�o r.h� c�se ��r �c�u�+a�� a� ��ic�ure €a�r which a builci�.n� parn�i� ha� b��n
�$u8d3 � B�f.d st�c�� �hall, �,ot be used cs� occup�ed ustil a���g�,fi.cate
of t��upancy h� bee� �ssu�4,
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sue�ecT P IT .
City of Fridley o 18052
AT THE TOP OF THE TWINS g U I L D i N G P E R M I T
r
; � RECEI .
� • COMMUNITY DEVELOPMENT DIV.
' �~ l� 99�
r � � PROTECTIVE INSPECTION SEC.
`I = �
--__ A �/"�,`j CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BY
i �� 612-571-3450 910-F15 6/10/85 / /
JOB ADDRESS 5273 Horizon Drive N. E.
1 LEGAL LOT NO. BIOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 7 8 Carlson� s. Summit Manor North SHEET
2 PROPERTY OWNER MAIL ADDRES$ ZIP PHONE
Ed FitzpatricJc 5273 Horizon Drive N.E. 572-9615
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Award Roofing 7801 Regent North 560-8849
4 ARCHITECT OR DESIGNEFl MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residentia,l
7 CLASS OF WORK
❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR 0 MOVE ❑ REMOVE
B DESCRIBE WORK
REY'00� DViiE1�.l.Y1C�
9 CHANGEOFUSEFROM TO
STIPULATIONS �of can be the 2nd layer but not the 3rd. Install ridged galvanized
valleys.
TYPE OF CONST. OCCUPANCY (3ROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR 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 CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOFi 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 1' STALLS GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES CiOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $�-I�SQ $.52
D S NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PR VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STR ION OR THE PERFORMANCE OF CONSTRUCTION. �I.9, OQ
� �� PLAN CHECKFEE TOTALFEE
$19,52
SIGNATUREOFC NTRACTORORAUTHOiiIZEDAGENT IDATEI WHEN PROPERL VALIDATED THIS IS YOUR PERMIT
' �"�,� �.��e � /� ��� --
SIGNATUREOFOWNERiIFOWNERBUILOERi IDATEI BLDG iNSP � TE
N� [] City of Fridley Effective �/1/8�
ADDN. [ ] R-1 AND R-2
pLTER. [ 7 Building Permit Applieation
Construction Address: �� � 3
Legal Desaription: C� r` � ��U� �� ZS�5 n.� °� ��� �� i ���,�' dl<��.��e� �
owner xame & Address : � ����Q '�� �� �� Tel. � �1��9��
Contractor e��� Q����� Tel .� bo `��y 9
Address:�� o �
LIVING AREA:
GARAGE AREA:
DECH AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, Hitb the proposed construetion drawn on it to seale.
DESCRIPTIOp OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.�
Corner Lot [] Inside Lot [] Ft. Yd. Setbaek Side Yard Setbaek
Type of Construction: Estimated Cost: $��S�
Approx. Completion Date: � 1201� �
Alt. A Alt H
Proposed DriveWay Width If New Opening Is Desired: � $
See Back�Page for Explanation
DATE: � 1�� � � APPLICANT: Tel. ��6� ��4
CITY IISE ONLY
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
SeWer Main Charge
TOTAL
STIPULATIONS:
$ /�.���
�
$ ��
$
$
�
$ f�°��°
Fee Schedule on Reverse Side
25� of Building Permit Fee
$.50/$1,000 Valuation
$425 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
s e -�
BDII.DING PERMIT FEE SC�DOLE
The Chief Building Official shall, before issuing permits for the erection of any
building or strueture, 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 sueh 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
Fees
$10.00 (Minimum Fee is $15.00)
$10.00 for the first $500 plus $1.50 for each
additional $100 or fraetion thereof, to and including
$2,000.
�32•50 for the first $2,000 plus $6.00 for each
additional $1,000 or fraction thereof, to and
ineluding $25,000.
$25,001.00 to $50,000.00 $170.50 for the first $25,000 plus $4.50 for each
additional $1,000 or fraction thereof, to and
ineluding $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
ineluding $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.
DRIYEfiAY DEPRBSSION ESCROii
(Concrete 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 ineh depth - Driveway width plus 6 feet times $15.75
11ERIFICATION OF FOUNDATION
Perm3ts 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 CertiPicate of Survey of the lot� showing the loeation of the foundation once it
has been constructed Kill be required before proceeding With the framing. '
.. _ �
sue�etr RMIT NO.
City of Fridley 3 0 6 2 0
�
AT TNE TOP OF TNE TW�NS g U I L D I N G P E R M I T
� ` RECEIPT NO.
� `v _ COMMUNITY DEVELOPMENT OIV. � ��
r � � � PROTEGTIVE INSPECTION SEC.
� . �
� _ �"'1 � CITY NA�L FRIOLE� 35132 NUMBEp REV O�TE P�GE Oc �PPnOVED Br
i �� � �
""�' � 612-571-3450 910-F15 1/5/00
JOB ADDRESS 5273 HORIZON DRIVE NE
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACMEO
DESCR. ] 8 Carlson's Summit Manor North Addition SNEET
2 PROPERTY OWNER MAIL ADORES$ ZIP PMONE
Charlotte Fitzpatrick 5273 Horizon Drive NE 572-9615
3 CONTRACTOR MAIL ADORESS 21P PMONE LICENSE NO
Seal Guard Systems 3770 Dunlap Ave N, Arden Hills MN 55112 717-0700
4 AFICHITECT OR DESIGNER MAI� AODRESS ZIP PMONE LICENSE NO.
20093688
5 ENGINEER MAII ADDRESS ZIP PNONE IICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WOFiK
❑ NEW O ADDITION ❑ ALTERATION C� REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WOFiK
Reroof House & Garage (22 Sq) Tear-off
9 CHANOE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYpE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAO
SEPARATE PERMITS ARE REGUIREO FOR ELECTRICAL, PLUMBING. NEATING.
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 OAVS. OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANOONEO fOii A PERI00 OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO DW4G. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I MAVE READ ANO EXAMINEO TNIS APPLICATION ]. STALIS GAFiAGES
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yp�VATION SURTAX
AND OROINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED @ @
WITM WHETHEfi SPECIFIEO MEREIN OR NOT. THE GRANTING OF A PERMIT `Pl f923 �p.96
DOES NOT PFESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL TNE pEqMIT fEE SAC CMARGE
PROVISIONS Of ANY OTHER STATE OR LOCAI LAW REGUTATING coN• �69 .2S F e SC y 1.92
STiiUCTION OR THE PERFORMANCE Of CONSTfiUCT10N
\?� PLAN CHECK f E TO Al FEE
•� Lice C $ . $77.13
•SIGNOTU �CON'AACTOpOAAUTNOp�ZEDOGENT IDATE� M P �V VALI O TMIS �S rOUA ER /�
� b �7
�
$�GN4TUNE O� OWNEp��� OWNEN BU�IOEA� I�ATEI p(� iN$ f�41E
N� [ ]
ADDN
ALTER
Effective 5/ 10/99
[ ] CITY OF FRIDLEY
[] SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUII.DING PERNIIT APPLICATION
Construction Address: r
Legal Description: '
Owner Name & Address:
Contractor: C( U
Address: � 3� r] � L,1,
LIVING AREA:
GARAGE AREA:
DECK AREA:
01'HER:
r i�.p n Y�� �� i�. I��,1, M��5�1 z!
��
l �� ��
'J �
?�,�`-'-`'= Tel. # �. ��
_ NIN LICENSE # ���� �
�1�� Tel.# �0��1�����-V
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction T . �.� �\� � �-1,l�l Estimated Cost: $ � �"� �� . ��J
YPe
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$,
DATE: �� APPLICANT: r I 1 I��" U�ll� Tel. #� ��� I����J �
Permit Fee
Fire Surcharge
Sta.te S�ircharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ � !�"J
$ �
$ �
$
$ • ��
$
$
$
$
� �,I�
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1I10th%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$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 [ ]
STIPULATIONS:
���� �
�
�
BUII,DING PERNIIT FEE SCHEDULE
The Chief Building Official sha11, 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,OQ1 to $5�,000
$500,001 to $1,000,0�
$1,00�,0p1 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.(�0 for each additional $1,000
or fraction thereof, to and including $25,OU0
$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 fraction thereof, to and including $1Q0,000
$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 addirional
$1,000 or fraction thereof, to and including $1,0(�,000
$5,608.75 for the first $1,000,000 plus $3.15 for each addirional
$1,000 or fraction thereof
DRIVEi�VAY DEPRESSION ESCROW
(Concrete Curb 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.
VERIFICATION OF FOUNDATION
Permit� for construction will be issued a minimum of 24 hours from the time of application to allow for proper
revie�v 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.
*
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,�q COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When realactna an existlns� furance, 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 plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No ()
The undersigned also verifles 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 �ppliances.
The existina combustion air is sized and installed to meet the current codes
and manufacturers specifications.
When required to install a new combustion air it will be sized and installed
to meet the cunent codes and manufacturer's specifications.
Yes ( ) No ( )
Yes (� No ( )
Yes ( ) No ( )
When installina a new ventina 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 (N' 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 current codes. Yes (y�j No ()
Appliance Tvae and Size/Commo� Went anc! Vent Connector Inforrnation
Appliance #1 Type ..�'�rn��ti. BTU Input _ 6C�, 'b� p Fan Assisted or Nat ��
Appliance #2 Type c�a�.�r- �..� 8TU Input 3c�. �J Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances .2 Total Btu Input `�o, �o
.____ ?
Common Vent Type �? �.,, d— Vent Height 6 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
ALTERATIONS: (Describe) �
HEATING CO: �c� ��.�,�� � ,,¢
Signed By: Date : /�� � � �� �
.
q
yY�; �
C[TY(JF
FR[DLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
February 7, 2003
Ms. Charlotte Fitzpatrick
5273 Horizon Drive NE
Fridley, MN 55421
Re: Final Inspection at 5273 Horizon Drive NE
Contractor: Action Heating & Air Conditioning
Dear Ms. Fitzpatrick:
A mechanical pernnit was issued on November 21, 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 pernait fee that was paid covers the inspection to make sure the work was completed
according to the Codes.
Please contact us within the next 30 days to schedule this inspection. To set up the
inspection or to have any questions answered, please contact the Building Inspection
Division at (763) 572-3604.
CinrPrPlv
DJ/mh
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COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When realacinq an existing furance, 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 plastic/PVC and meets all cuRent 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 specfications. 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 cuRent codes
and manufacturer's specifications.
When required to install a new combustion air it will be sized and installed
To meet the cuRent codes and manufacturers specifications.
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
When installina a new ventina 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 current codes. Yes () No ()
Appliance Tvpe and Size/Common Vent and Vent Connector Information
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
ALTERATIONS: (Desc�ibel
HEATING CO:
Signed By: Date :
3uilding
[nspections
763-572-3604 �
763-502-4977 FAX
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE i-1-08 _
Pernut No
Received By: / r �
Dat���: J��
�ATE 4° - a3 -�� YOUR E-MAIL ADDRESS ;�g�: � Y�C' S* S� CSl i Wli C�, CCs /i�
iITE ADDRESS J�% � 41CS� Zfc � `�� 1}�7e �J� tl �� �1 � ��y � 1
I'HIS APPLICANT IS: ❑ OWNER �ONTRACTOR
PROPERTY OWNER/ NAME:�j f` Pal ti f� S�S c2
'Y'Ei�1ANT �p�SS: � �� � � ar: �� fi OC• �W�= CITY �� � C�1 �V STATE�j1 �Z1P��
PHONE:
CONTRACTOR ,4nDR�.SS: I aa l O 1 S c1 �'''` Qu� CITY �+e� +rn ���� STA� W1 t�z� S�3oY
SUBMTf A COPY OF PHONE _,"��'�^�/I�"' 05 � L FAX '7Co3 `�-l(3 ^ P3'3f 7
YOUR STATE LICENSE STATE LICENSE # '� �� EXP DATE
PROPERTY TYPE I❑ SINGLE FAMILYMEW CONSTRUCTION
❑ TWO FAMILY/NEW CONSTRUCTION
PERMIT TYPE
TYPE OF WORK:
O BASEMENT FiNISH
❑ DECK
❑ NEW HOME CONSTRUCTION ❑ ADDITION
� �pN�gpp� �EMODEL
O DRAM 1'ILE
❑ OTHER
DESCRIBE WORK BE�AIG DONE: ^� ` � � �°� � ��` � � ��
eT�� n� rn,rvunvFtvrF.'1.TT � b��.SC� �� _LENGTH WIDTH HEIGHT
ROOFING
NUMBER OF SQUARES �
GARAGES ���
PROPOSED StZE:
PROPOSED HEIGHT:
SIDING
�v�yt
Aluminum
� Other
WIIVDOWS
IN EXISTING OPEMNGS ❑Yes ONo
OR FOR NEW OPEND�IGS-DESCRIBE STZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED
❑ HOUSE ONLY
�HOUSE & GARAGE
�1,ATTACHED GARAGE
❑ DETACHED GARAGE
BASEMENT REMODELING SUBMIT:
l. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
,ADDITIONS & PORCHES SUBNIIT:
fi�Soffit 1. Site Plan!$urvey showing the existing structures
❑ Trim and proposed project
I�.Fascia 2. Two sets of construction plans
3. Energy Calculations
LOCATION OF WINDOWS
JIU� ��
. ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING TH� 1� �UB� FEE SCHEDULE)
COTAL JOB VALUATION $ �-��'�� `�I O�CUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Chazge
�r..+ai n»P
$
$ �t� ��
$ � �"I�C�
$
$
$
$
$
$ ��l).-.
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the tota.l job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1825 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( ) '
Make checks p�able to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building pe►mit and I acknowledge that the information above is complete and accurate; thac t}►e work will be in conformance with the ordinances end codes
of the City of Fridley and with the Minnesota onstruction Codes; that I understand this is not a permit but only an application for a pertnit and work is not to start without a
permit on site; fhat the work will be in accor ce wi the approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME ��� ��I �.� DATE 9�E ��
DATE �
APPROVED BY _
Page 2- Building Residential Application
BUILDING PERNIIT FEE SCHEDULE
The Chief Building Official sha11, before issuing permits for the erection of any building or
structure, or for any addition to any existing building or structure, or for any altera.tion 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 FEES
$1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000 $23,50 for 1�` $500 plus $3.05 for each additional $100 or fraction, to and
includin $2,000
$2,001 to $25,000 $69.25 for 1�` $2,000 plus $14 for each additional $1,000 or fraction, to and
including $$25,000
$25,001 to $50,000 $39125 for 1�` $25,000 plus $10.10 for each additional $1,000 or fraction,
to and includin $50,000
$50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each additional $1,000 or fraction to and
includin $ I 00,000
$100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for each additional $1,000 or fraction to
and includin $500,000
$500,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75 for each additional $1,000 or
� fractionto and includin $I,000,000
$1,000,001 and up $5,608.75 for the 1�` $1,000,000 plus $3.15 for each additional $1,000 or
fraction
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to
a11ow for proper review of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required. before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432 '
763-572-3604
Fag: 763-502-4977